PROGNOSTIC FACTORS IN BLADDER AND BLADDER-PROSTATE RHABDOMYOSARCOMA

In order to examine surgical factors predictive of fatal outcome in patients presenting with histologically verified rhabdomyosarcoma of the urinary bladder, we performed a retrospective analysis of cases presenting between the years 1970 and 1985 and treated by protocol. Twenty-five patients were identified and data were complete for univariate and multivariate analysis on all. Staging was done according to the criteria of the international Union Against Cancer (TNM). Median age at presentation was 14.7 years and 10 patients were younger than 10 years. Median follow-up was 4.8 years overall and 8.4 years in survivors. Four patients presented with involvement of regional lymph nodes and three with distant metastases. Complete surgical resection, defined as negative microscopic margins, was accomplished by total cystectomy in 14 patients, and partial cystectomy in two. In this group cystectomy was performed prior to chemotherapy and radiation in five and after in 10 (persistent disease). Three salvage cystectomies were performed in patients who recurred after initial complete responses to chemotherapy and radiation therapy. Thirteen patients received a median of 3,000 cGy (range, 1,800 to 5,000 cGy) of external beam pelvic irradiation, and two received brachytherapy. All patients received multiple agent chemotherapy according to either the T2 or T6 protocol. There are 11 disease-free survivors (44%) and 10 of these have been followed for more than 6 years. One patient is alive with disease 6.5 years after diagnosis. Four variables were analyzed to determine their predictive effect on survival: (1) completeness of surgical resection; (2) prostatic involvement; (3) involvement of the urethral-trigonal area independent of the prostate; and (4) Primary tumor size (≤5 cm or >5 cm). In univariate analysis, using the maximum likelihood ratio test, prostatic involvement was the most significant predictor of mortality (P ≤ .04), whereas resectability (P ≤ .07) and tumor size (P ≤ .06) showed evidence of effect on survival. Urethral-trigonal origin of the primary was not associated with worsened prognosis. The associated relative risk of fatal outcome was 6.5 for prostatic involvement. Prostatic involvement was the most significant predictor of fatal outcome in multivariate analysis. We conclude that patients with rhabdomyosarcome of the urinary bladder originating in the prostate comprise a high-risk group. © 1990.