Patient Risk Profiles: Prognostic Factors of Recurrence and Progression

A vast array of pathologic features has been considered in the outcome of patients with Ta and T1 urothelial carcinoma. The problem, when analysing the factors related to recurrence, is that the published series may present different methodologic bias: short follow-up, small number of patients, different treatments, factors considered, and other. In addition, different clinical factors related to recurrence have been mentioned: multiplicity, size and location of the tumour, response to intravesical instillations, recurrence rate, and anaplasia. Related to progression, factors such as grade, association with carcinoma in situ (CIS), size of the tumour, and early recurrence have been considered. The author's experience with clinical prognostic factors of recurrence and progression is presented in order to decide on the best therapeutic approach. Experience shows that risk groups for recurrence may differ from those adopted for progression. For patients with low-grade tumors (grade 1 and the majority of grade 2 tumours) multiplicity is the main prognostic factor of recurrence and the main variable to consider when deciding on treatment. Once low-grade tumors become high grade, or in the case of CIS, progression has to be considered, and the tumour should be treated accordingly. In the case of high-grade tumours, although they may recur, progression is the main concern. Clinical prognostic factors may help to decide whether to manage them conservatively (bacillus Calmette-Guérin) or with radical cystectomy.