Transitional infiltrating carcinoma of the bladder. Local recurrence and metastases. Analysis of 175 cases treated with radical cystectomy
Escudero Barrilero, A.; Platas, A.; Jiménez, M.; Fernández, A.; Ruiz, C.; Rodríguez Luna, J.M.; Mayayo, T.; Mateos, A.
Archivos Espanoles de Urologia 42(4): 337-344
1989
ISSN/ISBN: 0004-0614 PMID: 2782963 Document Number: 338006
Although much has been written on transitional cell carcinoma of the bladder, little has been reported on its metastasis. We reviewed the records of 175 patients, 4 of whom died postoperatively. All patients had been followed until their death and the surviving patients recently evaluated. Sixteen patients were lost after a long follow-up. Most of the metastases were diagnosed within 18 months after the cystectomy. Sixty-one percent of the patients presented bony metastases. The risk of metastasis is greater for sessile tumors, and increases with the degree of vesical wall infiltration, anaplasia and lymph node involvement. Evidence of lymph node involvement is not necessary for metastasis to exist. There were significantly fewer patients who died with metastasis in the patient group that did not receive preoperative radiotherapy in comparison with the other two patient groups. Of the 11 patients who revealed no evidence of tumor in the surgical specimen, 2 metastasized, indicating that metastasis was present prior to cystectomy. Treatment with cytostatic agents is the only effective therapy against distant metastasis. In our view, all patients with a tumor invading perivesical fat or who present lymph node involvement, regardless of tumor stage, should receive chemotherapy after cystectomy as early as patient condition permits.