Two hundred and seventeen consecutive patients with superficial bladder cancer stages T(a)-T(1) were analyzed for survival and prognostic factors. The overall 5-year survival was 88 ± 5.3%. Factors that impacted significantly on survival were: grade of anaplasia (GI 92 ± 5.9% vs. GII 87 ± 7.5% vs. GIII 68 ± 20.7%; p = 0.01);increasing grade of anaplasia (98 ± 1.9% vs. 55 ± 15.6%; p < 0.0001); progression in tumor stage (100% vs. 58 ±12.5%; p < 0.0001); index of recurrences >0.7 (100% vs. 71 ± 10%; p < 0.0001); the presence of urothelial dysplasia (98 ± 1.7% vs. 77 ± 9.8%; p < 0.05); inflammatory infiltrate (90 ± 7% vs. 83 ± 7.3%; p < 0.01), and residual tumor post-TUR (89 ± 5.5% vs. 68 ± 18.6%; p < 0.001). Tumor stage did not impact on survival (p >0.05). Using multivariate statistical analysis only the grade of anaplasia (p < 0.0001) and increasing grade of anaplasia (p = 0.001) demonstrated significant prognostic value. Eight percent of patients died because of tumor progression. Of these patients, 87% were T(1) and had concomitant urothelial dysplasia. Twenty-five percent had carcinoma in situ and the mean index of recurrence was 1.59. Seventy-five percent of patients dying because of tumor progression developed muscle-infiltrating cancer (>T(2)GIII) and 25% developed previously metastatic spread without evidence of local progression (T(1)GIII). The grade of anaplasia and increasing grade of anaplasia predict accurately the likelihood of death secondary to local progression and/or metastatic spread. However, in the evaluation of individual patients, factors as tumor stage, urothelial dysplasia, carcinoma in situ and mean index of recurrence should also be considered.

Keywords:
Bladder cancer, Prognostic factors, Survival, Increasing grade of anaplasia
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