PROGNOSTIC VALUE OF AN ANALYSIS OF THE EFFECTS OF STROMA OF TRANSITIONAL CELL CARCINOMAS OF THE URINARY BLADDER

THE AIM of the investigation was to study the number and composition of cellseffectors of the urinary bladder carcinoma stroma, to compare them with the depth of invasion, differentiation degree, of cancer and survival of the patients. PATIENTS AND METHODS. The data of a primary examination and a fiveyear dispensary followup after radical surgery of 60 patients with transitional cell carcinomas of the urinary bladder (TaT4, NX, M0) were investigated retrospectively. The ratio of men and women was 3.3:1, mean (±SD) age was 63±1 years. In addition to the standard morphological investigation with magnification 600ґ in 7 fields of vision the stroma effectors were counted. Fiveyear survival without progression was 63%, recurrences was noted in 62% of cases. RESULTS. The number of effectors increased with the increase of cancer invasion (p=0.057); in tumors pTa there was less number of lymphocytes (p=0.020) and macrophages (p=0.024). In G1 carcinomas there were fewer plasmatic cells (p<0.001) and macrophages (p=0.009), while in tumors G3 there were more eosinophilic leukocytes (p=0.026). There were more recurrences of tumors with a great number of stroma lymphocytes (p=0.057), and carcinomas pTapT1 also with a less number of segmentonuclear lymphocytes (p=0.042). Fiveyear survival of the patients was characterized by a less number of effectors (p=0.007) and, in particular, of lymphocytes (p=0.024) and segmentonuclear leukocytes (p=0.037). The multiple regression analysis has shown that the leading signs associated with the survival proved to be the invasion depth (p=0002), SD of the mast cells (p=0.041) and number of the lymphocytes (p=0.070) of the stroma. The differentiation degree did not reach the reliability threshold. In the subgroup pTapT1 the determination of the probability of fiveyear survival by the calculation of the number of the segmentonuclear leukocytes (p=0.009) and lymphocytes (p=0.025) of the stroma was more exact (R2  =0.32; p=0.008) as compared with using traditional characteristics  pT and G (R2=0.29; p=0.022). CONCLUSION. An analysis of the stroma effectors of transitional cell carcinomas allowed additional prognostic information to be obtained that can be a prerequisite for recommendation of the corresponding regimens of measures of treatment and postoperative followup.

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