Clinical variables which serve as predictors of cancer‐specific survival among patients treated with radical cystectomy for transitional cell carcinoma of the bladder and prostate

• Published in: Cancer 1994-03, Vol.73 (6), p.1708-1715
• Main Authors: Thrasher, J. Brantley, Frazier, Harold A., Robertson, Judith E., Dodge, Richard K., Paulson, David F.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; bladder cancer; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; clinical prognosticators; Cohort Studies; Combined Modality Therapy; Creatinine - analysis; Cystectomy - methods; Female; Follow-Up Studies; Forecasting; Hemoglobins - analysis; Humans; Male; Medical sciences; Middle Aged; Neoplasm Staging; Nephrology. Urinary tract diseases; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; radial cystectomy; Regression Analysis; Retrospective Studies; Smoking; Survival Analysis; Survival Rate; transitional cell carcinoma; Tumors of the urinary system; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary Diversion; Urinary tract. Prostate gland
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19940315)73:6<1708::AID-CNCR2820730626>3.0.CO;2-J

Background. Studies have demonstrated conclusively that the stage and grade of transitional cell tumors at presentation are major determinants of survival for those with the disease in the bladder and prostate. The authors initiated a review of 531 patients with transitional cell carcinoma of the bladder and prostate treated with radical cystectomy between 1969 and 1990 to identify other clinical features predictive of cancer‐specific survival. Materials and Methods. Inpatient and clinical medical records were analyzed for age, race, gender, clinical T stage, medical history, and presenting symptoms and signs, and admission laboratory values were correlated with the patient's cancer‐specific outcome. Both univariate and multivariate analyses of the various clinical factors were performed to identify variables predictive of cancer‐specific survival. Results. Univariate analysis indicated that clinical T classification, preoperative hemoglobin, tumor grade, irritative voiding symptoms, age, preoperative creatinine, obstructive hydronephrosis on preoperative excretory urography, a history of bladder tumors or nephrour‐eterectomy for transitional cell cancer, prior urinary tract infections, prior pelvic irradiation, and obstructive symptoms were all predictive of poor cancer‐specific survival. Multivariate analysis demonstrated that higher clinical T classification (T2, T3a, T3b, T4 versus Ta, Tis, T1) (P < 0.001), increasing age (> 65 years versus < 65 years) (P < 0.001), the presence of irritative voiding symptoms (P = 0.01), higher tumor grade, lower preoperative hemoglobin level (≤ 12 gm/dl versus > 12 gm/dl) (P < 0.001), higher preoperative creatinine level (≥ 1.5 mg/dl versus < 1.5 mg/dl) (P = 0.002), a history of nephroureterectomy for transitional cell cancer (P = 0.016), and a history of pelvic irradiation (P = 0.002) were all predictive of poor cancer‐specific survival. Conclusions. Although clinical T classification and tumor grade remain the best predictors of survival in patients with transitional cell carcinoma of the bladder or prostate, clinical variables such as age, preoperative creatinine and hemoglobin levels, a history of nephroureterectomy or pelvic irradiation, and irritative voiding symptoms at presentation may provide additional prognostic information independent of tumor grade and stage.