Objective: To determine the natural history of transitional cell carcinoma (TCC) of the bladder, and to identify factors which place patients at lifelong risk of developing progression and dying from bladder carcinoma.
Patients and methods: The long-term outcome was evaluated retrospectively in 231 patients with superficial bladder TCC, assessed for the first time within a 6-year period from 1981 to 1986, with a median follow-up of 108 months. Of 231 patients, 217 (94%) were initially treated by transurethral or segmental resection.
Results: Recurrence developed in 141 of 217 (65%) patients; the duration of the interval free of recurrence was significantly less for patients with initial G3 tumours than that for those with G1 (P<0.01) and for pT1 compared with pTa disease (P<0.01). The disease progressed in 42 of 231 (18%) patients. Differences in the progression-free interval between patients with G1 and G3 tumours, and with pTa and pT1 disease, were statistically significant (P<0. 005 and P<0.001, respectively). In 27 of 231 patients (12%), TCC of the bladder was the cause of death, whilst 118 (51%) died from unrelated causes. There were no deaths among patients with initial pTaG1 tumours, compared with 10 of 26 (38%) deaths in those with pT1G3 disease at presentation.
Conclusion: The long-term prognosis is good for patients with pTaG1 tumours, whilst pT1G3 is a potentially aggressive disease. Lifelong endoscopic surveillance is mandatory in patients in whom new tumours are very active, at least in those of younger age. Routine cystoscopy can possibly be discontinued in patients with low-grade, low-stage disease in whom a low liability of recurrence has been shown during follow-up.