[Modern follow-up strategies for the treatment of patients with superficial bladder carcinoma]. / Moderne Nachsorgestrategien beim oberflächlichen Harnblasenkarzinom.

ABSTRACT

In this retrospective study the efficacy of tumor dispensaire in patients with superficial transitional cell carcinoma of the bladder was investigated in a population of 246 patients. Special attention was payed to follow up cystoscopy. Furthermore our goal was to identify and confirm prognostic factors relevant to recurrence rate and tumor progression. After transurethral resection 241 patients suffering from superficial bladder cancer were enclosed. The first of them were diagnosed in 1984 with a mean follow up range of 6.1 years and a minimum of 1 year. The evaluation was closed in 1995. The 1-year recurrence free rate of all cases amounts to 60%, whereas 42% of patients with a pT1-primary tumor and 45% with a pTa-primum developed a relapse within 2 years after the first diagnosis. All in all more than 50% of all recurrent tumors occurred within the first two years if illness. Patients with pTa and pT1 tumor are progressed in 10.7% and 18%. In 8% we saw lymphogen metastases in patients with pT1 carcinoma. 149 patients (62%) were followed up exactly (+/- 1 cystoscopy) according to the investigation schedule. More than +/- 3 aberrant cystoscopies contrary to the follow up instructions happened very seldom. Prognostic factors to be found of significance for tumor progression and recurrence risk are tumor staging and grading, multiplicity in occurrence, period of time between first diagnosis and first relapse, associated dysplasia or carcinoma in situ. Chest X-ray and urography should be performed in accordance to the patients individual clinical situation, not routinely (2 cases of pulmonary metastasis occurred after pT1G2-3 tumor progression in 496 regular chest X-rays and 1 ureter tumor was diagnosed by routine urography). As a main result of our investigation we defined two groups of patients with superficial bladder cancer a "low risk" group (pTa, G1-2, late recurrence (> 2 yrs.) and a "high risk" group (pT1, G3, early recurrence (< 2 yrs.), multifocal occurrence). Group 1 ("low risk") should be followed up for 5 years and group 2 ("high risk") for 10 years. Cystoscopic investigations are scheduled with regard to the group risk of recurrence and tumor progression. For patients of both groups the need of chest X-ray and urography should be evaluated individually.