Prognostic factors of superficial urinary bladder cancer patients in a northern medical center

• Main Authors: Yen-Chieh Wang, 王彥傑
• Other Authors: Mei-Shu Lai
• Format: Others
• Language: en_US
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/85828174153031537620

碩士 === 國立臺灣大學 === 預防醫學研究所 === 96 === Objectives: We analyzed the prognostic factors of recurrence and cancer-specific survival in patients with primary superficial bladder cancer. The present data are collected from a medical center in northern Taiwan. Material and Methods: This retrospective cohort study collected 115 newly diagnosed patients with primary superficial bladder cancers at the Cathay General Hospital from January 1998 to December 2002. Most (103, 89.6%) patients underwent transurethral resection of bladder tumors. 7 and 5 patients underwent partial and radical cystectomy, respectively. 105 patients received bladder instillation postoperatively with agents including bacille Calmette-Guérin (BCG), adriamycin, or mitomycin C. Patients were followed by cystoscopy every three months during the first year, every six months during the second year, and every twelve months subsequently. Kaplan-Meier survival analysis was used in order to evaluate the influence of different variables on prognosis. Log-rank test was utilized to verify significance of variables in this survival analysis. Multivariate Cox proportional-hazard regression analysis was performed to analyze the significant variables at 0.15 level from the univariate analyses. Results: In our study, the average age of patients was 69.5 years and the average follow-up period was 61.2 months. Recurrence-free rates in patients after five and ten years were 36.7 % and 32.0 %, respectively. Cancer-specific survival rates after five and ten years were 70.2 % and 60.9 %, respectively. Based on univariate analysis, recurrence of urinary bladder cancer was statistically significant for gross tumor shape, tumor multifocality, pathological tumor stage, pathological tumor grade, creatinine level, tumor size, and hemoglobin level; cancer-specific survival of urinary bladder cancer was statistically significant for age, gross tumor shape, tumor size, pathological tumor stage, pathologic tumor grade, hemoglobin level, liver function test, and postoperative hospital stay. After the univariate analysis, we selected above-mentioned significant factors to conduct multivariate Cox proportional-hazard regression model. The analysis showed that tumor size is the most significant determinant for cancer recurrence, followed by gross tumor shape and tumor multifocality. This model composed of three determinants yielded hazard ratios of: 3.2 for tumor size (≧2cm versus <2cm), 2.7 for gross tumor shape (non-papillary versus papillary), and 2.3 for tumor multifocality (unifocality versus multifocality). In addition, the multivariate analysis showed that gross tumor shape is the most significant determinant for cancer-specific survival, followed by liver function test and tumor size. This best model composed of three determinants yielded hazard ratios of: 6.8 for gross tumor shape (non-papillary versus papillary), 3.2 for liver function test (abnormal versus normal), and 2.8 for tumor size (≧2cm versus <2cm). Conclusions: Non-papillary tumor and the largest tumor greater than or equal to 2 cm were risk factors of recurrence and cancer-specific mortality. Tumor multifocality was a risk factor of recurrence. Abnormal liver function test influenced cancer-specific survival in our cohort patients; this new finding may be helpful for predicting the prognosis of primary superficial bladder cancer in Taiwanese patients.