NORMAL”︁ urothelium in patients with bladder cancer. A preliminary report from the national bladder cancer collaborative group a

• Published in: Cancer 1979-09, Vol.44 (3), p.1050-1058
• Main Authors: Murphy, William M., Nagy, George K., Rao, Moparti K., Soloway, Mark S., Parija, Gopal C., Coxii, Clair E., Friedell, Gilbert H.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma in Situ - pathology; Carcinoma, Transitional Cell - pathology; Female; Humans; Hyperplasia; Male; Middle Aged; Mucous Membrane - pathology; Neoplasms, Multiple Primary - pathology; Prognosis; Recurrence; Urinary Bladder - pathology; Urinary Bladder Neoplasms - pathology
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(197909)44:3<1050::AID-CNCR2820440337>3.0.CO;2-N

The concept that most bladder carcinomas arise from a widespread reaction of urothelial cells to various carcinogenic stimuli is widely accepted. The evidence for this theory rests largely on retrospective evaluations of nontumorous urothelium obtained from patients with concomitant or sinecomitant bladder cancers. A prospective surveillance study of patients with bladder cancer has been conducted at the University of Tennessee Center for the Health Sciences, a collaborating institution of the National Bladder Cancer Collaborative Group‐A, to determine the frequency, distribution, and biologic significance of hyperplasia, dysplasia, carcinoma in situ (CIS), and carcinoma in the cystoscopically unremarkable urothelium of patients with carcinoma of the bladder. Multiple mucosal biopsies were obtained at cystoscopy from preselected sites in 64 patients. Specimens were collected both when tumors were visible and when no tumor was seen. Of the 657 evaluable specimens, 94 (14.3%) were positive for either hyperplasia, dysplasia, carcinoma in situ, or carcinoma (invasive and/or papillary, noninvasive). In general, the frequency of positive biopsies increased with advancing histologic grade of the primary neoplasm. When possible, incomplete resection of the primary tumor was taken into consideration; there was no statistically significant difference between frequency of positive specimens collected from sites adjacent to versus distant from the original neoplasm. Patients were no more likely to have abnormal urothelium when a tumor was cystoscopically visible than when no tumor was apparent, but lesions occurring in the presence of a tumor tended to be of greater histologic severity. The biologic significance of flat, noninvasive urothelial lesions (hyperplasia, dysplasia, CIS) can be determined only after longer periods of observation, but preliminary results indicate a borderline statistical significance (p ≅ 0.10) for these abnormalities in the prediction of subsequent recurrence or new occurrence of bladder cancer.