Studies of transitional cell tumours of the bladder. Prognosis and causes of death.

Transitional cell tumours of the bladder from a total of 228 patients were histologically classified as papillomas, papillomatous carcinomas and non-papillomatous carcinomas. Each group was subdivided into four grades of dysplasia. Papillomas and papillomatous carcinomas occurred in younger patients at a higher rate than non-papillomatous carcinomas. The 5-year-survival of patients with papillomas and carcinomas was 70 per cent and 26 per cent, respectively. Among patients with papillomas with dysplasia grades 1 and 2 the survival rate was almost identical. In the group of patients with papilloma thrombo-embolic diseases were the most common cause of death. Carcinoma of the bladder developed in about 30 per cent of the patients in this group. Recurrence of the papilloma only rarely changed the grade of dysplasia. If the recurrence was in the form of a carcinoma, an increase in the grade of dysplasia was common. The survival was more favourable among patients with carcinoma dysplasia grade 2 than among those with dysplasia grade 3. The rate of survival was higher in the group of patients with papillomatous carcinoma than among patients with non-papillomatous carcinomas. Among the decreased patients with primary carcinomas, 77 per cent died with carcinoma of the bladder. To a certain degree, the grade of tumour cell dysplasia seems to be an expression of the malignancy of the tumours. The duration of the disease and the appearance of tumours (papillomatous, non-papillomatous) may have relation to the patients' "defence" system. At autopsy, the papillomatous and non-papillomatous carcinomas were found to be similarly disseminated regardless of the difference in survival rate.