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Partial Cystectomy Treatment & Management

  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Mar 26, 2014
 

Medical Therapy

Bladder-sparing options other than partial cystectomy

In the United States, most young healthy patients with urothelial carcinoma are treated with radical cystectomy as the criterion standard treatment because of survival advantages seen in large series.[23]

Several other studies have been published using treatment protocols involving systemic chemotherapy or external beam radiation (XRT). Multimodality bladder-sparing therapy usually includes complete transurethral resection followed by induction chemotherapy/radiation, repeat urological evaluation (biopsies or repeat transurethral resection), and, afterwards, consolidation chemotherapy/radiation. Salvage cystectomy is offered to patients without response to induction therapy or if recurrence is detected.

Table 2. Options Other than Partial Cystectomy (Open Table in a new window)

Study Number of Patients Induction Therapy % Complete Response Consolidation Therapy % Overall Survival (years) % Overall Survival with Bladder Intact (years)
Housset et al 120 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil 77 Bifractionated XRT + concurrent 5-fluorouracil + cisplatin 63 (5)  



...



Sauer et al 184 45-54 Gy XRT + concurrent cisplatin or carboplatin 80 None 56 (5) 41 (5)
Fellin et al 56 2 cycles MCVa, 40 Gy XRT + concurrent cisplatin 50 24 Gy XRT + concurrent cisplatin 55 (5) 41 (5)
Tester et al 49 40 Gy XRT + concurrent cisplatin 66 24 Gy XRT + concurrent cisplatin 60 (4) 42 (4)
Tester et al 91 2 cycles MCV, 39.6 Gy XRT + concurrent cisplatin 75 25.2 Gy XRT + concurrent cisplatin 62 (4) 44 (4)
Shipley et al 61 2 cycles MCVa, 39.6 Gy XRT + concurrent cisplatin 61 25.2 Gy XRT + concurrent cisplatin 48 (5) 36 (5)
Shipley et al 62 39.6 Gy XRT + concurrent cisplatin 55 25.2 Gy XRT + concurrent cisplatin 49 (5) 40 (5)
Kachnic et al 106 2 cycles MCV, 40 Gy XRT + concurrent cisplatin 66 24.8 Gy XRT + concurrent cisplatin 52 (5) 43 (5)
Zietman et al 18 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil 78 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil + 3 cycles MCV 83 (3) 78 (3)

a Methotrexate, cisplatin, and vinblastine[24]

Multimodality bladder-sparing approaches other than partial cystectomy yield 5-year overall survival rates of 48-56%, with 5-year bladder survival rates of 36-43%. Comparison between approaches is difficult because of the multiple variables which may affect survival differ significantly between study populations. To date, no prospective randomized studies among modalities have been performed, so data must be interpreted accordingly.

The most important factors for bladder-sparing therapies include appropriate patient selection and long-term surveillance. Patient factors that increase risk of failure in transurethral resection/chemoradiation protocols include clinical stage higher than T2, associated ureteral obstruction with hydroureteronephrosis, incomplete initial transurethral resection, multiple tumors, and lack of response to induction chemoradiation. Local recurrence rates for such protocols vary from 20-30%. A recent editorial estimated that the mortality risk of certain bladder sparing procedures was between 7-16%.[25]

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Preoperative Details

Initial TURBT should confirm that the patient is a good candidate for partial cystectomy (absence of multifocal tumors, no carcinoma in situ, good bladder capacity.) During TURBT, a thorough inspection is performed and necessary biopsy samples collected to ensure that no other portions of the lower urinary tract contain disease. Appropriate imaging staging studies are performed (see Imaging Studies) to ensure that no disease exists in the upper urinary tracts or outside the bladder. Preoperative history, physical examination, medical assessment, and necessary laboratory evaluation (see Lab Studies) are also performed.

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Intraoperative Details

The patient may be placed in the supine or low-lithotomy position with a slight amount of Trendelenburg positioning. Bimanual examination under anesthesia is performed to determine suitability for resection. A catheter is inserted through the urethra, and the bladder is instilled with Mitomycin C (1 mg/mL) to decrease local tumor spillage. The Foley catheter is clamped so that the intravesical chemotherapy remains inside the bladder, and the bladder is allowed to partially expand, which facilitates dissection.

The surgical approach is either transperitoneal or extraperitoneal through a lower midline incision. The transperitoneal approach may be more suitable for tumors located posteriorly. Pelvic lymph node dissection can be performed before or after partial cystectomy. In urothelial carcinoma, it is known that improved survival can be achieved with extended pelvic lymph node dissection.[26]

After completing the pelvic lymph node dissection, the Mitomycin C is drained from the bladder into a contained Foley bag system and discarded according to biohazard principles. Next a combined endoscopic and open approach is utilized to ensure resection of the mass with adequate tumor margins. A flexible cystoscope is introduced via the urethra into the bladder. While the assistant surgeon displays the location of the mass on the video monitor with the cystoscope, the primary surgeon can now see exactly where to place four sutures (inferior, superior, medial, lateral) strategically into the detrusor muscle of the bladder, to outline the exact area to be resected.

Next, the bladder is mobilized while dividing the vas deferens and the obliterated hypogastric artery. A portion of the ipsilateral vascular pedicle including the superior vesical artery is divided and ligated. The superior vesical artery division is especially helpful in the lateral mobilization of the bladder to expose a posteriorly located lesion. The tumor is excised with a 1-cm to 2-cm margin. The perivesical fat and the overlying peritoneum are removed, if necessary, with care to protect both ureters and the rectum. Frozen sections of the specimen are sent for analysis to ensure negative surgical margins.

An alternative method of excision involves placement of a Satinsky clamp around the portion that contains the tumor, excision of the segment, and cauterization of the wound edges.

The bladder is closed in 2-layers, and drains are placed in the perivesical space. A suprapubic tube is avoided because of possible tumor spread. Bladder drainage is managed with a temporary Foley catheter. Tumor spillage is detrimental and can be prevented via instillation of intravesical chemotherapy into the bladder prior to making the lower midline incision, careful draping, and meticulous isolation and manipulation of the tumor. The wound edges should be protected and the wound copiously irrigated with sterile water prior to closure. Concurrent procedures, such as prostatic adenoma enucleation or transurethral incisions of the bladder neck for bladder outlet obstruction, should be avoided because of the risk of tumor implantation in the prostatic bed.

Partial cystectomy can also be performed laparoscopically or robotically with similar technique to open prodecures.[27, 28] The patient is placed in the extreme Trendelenburg position with his or her legs abducted in Allen stirrups. A 5-mm port may be used for a transperitoneal approach. The camera port is positioned at least 2-3 cm above the umbilicus to facilitate adequate mobilization of the urachal remnant. The peritoneum is incised lateral to each medial umbilical ligament, and the urachus and peritoneum along with the surrounding pre-peritoneal fat are widely mobilized en bloc.

Once the space of Retzius is fully developed and the bladder is completely mobilized, the tumor is typically identified. A circumferential cystotomy is made under simultaneous cystoscopic guidance (with or without cystoscopic tattooing) at a distance of 2 cm from the tumor to provide an adequate margin. The surgical specimen is then immediately placed into an EndoCatch bag (USCC, Norwalk, CT).

Bladder margins are sent for frozen section analysis and the bladder is then closed in 2 layers. The retrieval bag is removed through an extension of the camera trocar site, and a Jackson Pratt drain is positioned in the prevesical space through one of the previous trocar sites. In selected patients, with skilled surgeons, laparoscopic or robotic approaches can afford the patient a shorter recovery time and hospital stay.[29, 30]

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Postoperative Details

Placement of a drain in the perivesical space and maintaining a large caliber urethral catheter helps facilitate healing of the suture line where the bladder has been repaired. Ideally, the bladder is kept decompressed and any initial urine leakage is drained to allow healing of the bladder suture line. A urethral catheter also allows monitoring of urine output and detection of hematuria. This catheter is usually left in place for 7-14 days postoperatively. A cystogram may be obtained prior to catheter removal to ensure that the bladder suture line has healed.

Rarely, intravesical bleeding may result in urinary clot retention and may require gentle bladder irrigation to evacuate clots. Postoperative wound infection or abscesses may require open or percutaneous drainage. Ureteral obstruction should be suspected if the patient reports flank pain. IVP or ultrasonography can be used to confirm this diagnosis, and percutaneous nephrostomy may be used to temporarily divert urine in the hope that the obstruction is temporary. Incontinence due to altered bladder compliance and uninhibited bladder contractions usually improves with time and anticholinergic medications.

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Follow-up

Careful monitoring of all patients with bladder cancer is mandatory as bladder cancer frequently recurs. Cystoscopy should be performed every three months initially with voided urine cytology and frequent imaging.

Upper urothelial tract imaging with IVP, CT urography, or retrograde pyelography is also necessary although recurrence in the upper tract is less common. A precise surveillance schedule should be determined on an individual basis, and patients with high-grade tumors should be monitored for disease recurrence and progression for life.

For excellent patient education resources, see eMedicineHealth's patient education article Bladder Cancer.

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Surgery: partial cystectomy

Initial transurethral resection of bladder tumor (TURBT) is essential for adequate staging in order to make an informed decision about future therapy. In general, partial cystectomy involves removing the segment of diseased bladder and repairing the defect with or without performing pelvic lymph node dissection. Radical cystectomy involves removal of the bladder, prostate and seminal vesicles in men. In women, along with the bladder, the urethra, uterus, broad ligaments, and anterior third of the vaginal wall may be removed. Pelvic lymphadenectomy is performed and a urinary diversion is created which may include ileal conduit, neobladder or continent pouch. The remainder of this article discusses details for partial cystectomy only.

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Complications

Excluding recurrence of malignant disease, the overall complication rate of partial cystectomy is reported as 11-29%, with recent literature suggesting lower complication and mortality rates at higher-volume centers.[31] Common complications of partial cystectomy include: bleeding, infection, reduction of bladder capacity, and urinary extravasation. Less commonly, some patients develop fistulas (vesicocutaneous, vesicovaginal, colovesical). Other complications include those that are possible in any major surgery: myocardial infarction, pulmonary embolus, congestive heart failure, upper gastrointestinal hemorrhage, and death. Laparoscopic urologic surgery complications occur with a rate of 14.6%, although the rate of complications specific to laparoscopic partial cystectomy is not known.

Importantly, the recurrence rate of bladder cancer after partial cystectomy is reported to be 37-78%. Local recurrences in the wound or suprapubic tract are worrisome and have been reported in as many as 18% of patients. Peress et al noted that those with high-grade tumors were more likely to have local recurrences than low-grade tumors (54% to 0%).[32]

Perioperative mortality rates once approached 10%, although more recent studies have reported rates of 1-2%.

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Outcome and Prognosis

Recurrence

The major disadvantage of partial cystectomy compared with radical cystectomy is an increased bladder recurrence rate in addition to metastatic recurrence. Recurrence also implies a risk of disease progression, metastasis, and death from cancer. In many patients, salvage with radical cystectomy is not possible, and some series report high death rates in patients who recur. Recurrence rates associated with partial cystectomy have been reported as 19-78%. Relapses seem to be influenced by tumor stage T3b, poorly differentiated (grade III) tumors, and tumor size (>4 cm). Various studies and their corresponding recurrence rates are as follows:

Table 3. Various Studies and Their Corresponding Recurrence Rates (Open Table in a new window)

Studies Recurrence rates
Resnick and O'Connor (1973) 76%
Evans and Texter (1975) 40%
Novick and Stewart (1976) 50%
Peress et al (1977) 54%
Cummings et al (1978) 49%
Schoborg et al (1979) 70%
Faysal and Freiha (1979) 78%
Jardin and Vallencien (1984) 78%
Lindahl et al (1984) 58%
Kaneti (1986) 38%
Dandekar et al (1995) 43%
Holzbeierlein et al (2004) 19%
Kassouf et al (2006) 49%
Knoedler et al (2012) 43%

 

Peress et al noted that preoperative grade is an important prognostic factor in determining the risk of recurrence after partial cystectomy.[32] They studied 61 patients with stage A transitional cell carcinoma and found that 54% of patients with high-grade lesions experienced recurrence after partial cystectomy and eventually died of their disease. Kassouf et al have shown that a higher pathological stage at time of partial cystectomy was associated with shorter recurrence-free survival. Smaldone et al found that only tumor size at time of partial cystectomy was associated with tumor recurrence.[33] Older studies by Resnick and O'Connor and by Faysal and Freiha have also confirmed these findings.[34, 35]

These high local recurrence rates reflect the natural history of bladder cancer. Urothelial carcinoma of the bladder may affect the urothelium globally in some patients. Recurrences and survival outcomes depend on tumor stage and grade. Conservative management of Ta-T2 disease with transurethral resection alone results in a 60% recurrence rate. Those patients with history of previous tumors have an 84% recurrence rate, with nearly half of all tumor recurrences being multifocal. At initial presentation, two thirds of urothelial cancer patients have superficial (Ta, T1) disease, and two thirds of these patients experience recurrence (with 20% of the recurrences being of a higher grade). Death from urothelial carcinoma occurs in 5% of patients with grade 1 disease, 16% of patients with grade II disease, 28-35% of patients with grade III/stage Ta disease, and 83% of patients with grade III/stage T2 disease.

Recurrent local disease may be treated with transurethral resection, intravesical chemotherapy, radiotherapy, repeat partial cystectomy, and radical cystectomy. Of all patients who undergo partial cystectomy as original therapy, 4-15% eventually undergo radical cystectomy. Salvage radical cystectomy may confer prolonged survival, though prognosis is largely related to pathological tumor stage and nodal status.[36]

Survival

Many studies have examined the survival of patients with bladder cancer after partial cystectomy. Survival is influenced by tumor stage, grade, and histology. Accurately interpreting the impact of partial cystectomy on overall survival and comparing to results of radical cystectomy data is difficult. Most partial cystectomy series are small (usually < 50 patients) compared to radical cystectomy series of more than 1000 patients. Also, many partial cystectomy series are carefully selected for lower risk tumors prior to surgery, which may influence survival. Furthermore, pelvic lymph node dissection, which has been shown to have a significant survival benefit,[26] is frequently underutilized in partial cystectomy series.[37]

Data from Kassouf et al showed that patients undergoing partial cystectomy who had a prior history of superficial tumors had a decreased overall and advanced recurrence-free survival.[38] This finding is not surprising given that these patients have already demonstrated evidence of a global field effect within the urothelium

When comparing results for a given stage or grade of urothelial bladder cancer, survival outcomes for partial cystectomy series have been worse compared with radical cystectomy series. Five-year survival rates vary from 35-70%, compared with the reported 50-88% survival rate of contemporary radical cystectomy series. However, a recent matched case-control analysis (with patients matched based on age, sex, pathological T stage, and receipt of chemotherapy) showed no difference in metastasis-free or cancer-specific survival when comparing patients undergoing partial cystectomy with those undergoing radical cystectomy, although partial cystectomy patients remain at high risk for recurrence.[39]

Neoadjuvant chemotherapy has been shown in randomized trials to improve overall survival in patients undergoing radical cystectomy[40] although it is unclear whether adjuvant therapy would be equally effective.[41] Adjuvant chemotherapy should be considered in patients with extravesical extension or pelvic lymph node metastases who undergo partial cystectomy.

Table 4. Survival Rates by Tumor Grade (Open Table in a new window)

Source Five-year Survival (%) Ten-year Survival (%)
Grade I Grade II Grade III/IV Grade I Grade II Grade III/IV
Magri (1962)  



88



33 34 - - -
Utz et al (1973) 100 48 39 - - -
Novick and Stewart (1976) 100 75 40 0 67 8
Brannan et al (1978) 50 62 55 50 33 30
Cummings et al (1978) 100 96 32 - - -
Schoborg et al (1979) 75 62 26 50 28 4
Faysal and Freiha (1979) 100 53 30 25 20 8
Merrell et al (1979) 78 56 22 83 32 0
Kaneti (1986) 75 46 46 - - -
Dandekar et al (1995) 100 94.4 53.5 - - -

Table 5. Survival Rates by Tumor Stage (Open Table in a new window)

Source Five-year Survival (%) Ten-year Survival (%)
T0 T1 T2 T3 T4 Overall T0 T1 T2 T3 T4 Overall
Magri (1962) - 80 38 26 0 42 - - - - - -
Long et al (1962) 80 67 43 9 0 - - - - - - -
Cox et al (1969) - - 20 16 - - - - - - - -
Resnick and O'Connor (1978) 75 71 77 12.5 20 35 - - - - - -
Utz et al (1973) - 68 47 29 0 39 - - - - - -
Evans and Texter (1975) - 69 43 14 0 0 - - - - - 21
Novick and Stewart (1976) - 67 53 20 - 46 - 67 44 - - 36
Brannan et al (1978) 100 69 54 33 0 57 - 31 36 11 - 32
Cummings et al (1978) - 79 80 6 - 60 - - - - - -
Schoborg et al (1979) 69 69 29 12 100 43 - 37 0 0 0 12
Faysal and Freiha (1979) 75 58 29 7 0 40 21 15 13 7 0 9
Merrell et al (1979) 100 100 67 25 - 48 - 100 33 0 0 32
Lindahl et al (1984) - 59 38 - - 42 - 48 25 - 0 38
Kaneti (1986) - 68 40 33 0 48 - - - - - -
Smaldone et al (2008) - - - - - 70            
a Stage T3a/T3b
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Future and Controversies

Partial cystectomy offers potential quality of life advantages over radical cystectomy and may be appropriate in selected patients with cancer or certain benign conditions.

In patients with urothelial cancer, partial cystectomy will probably continue to play a limited role in the absence of quality comparative studies demonstrating equivalent survival results to radical cystectomy. The improved quality of life and fewer complications seen in patients undergoing partial cystectomy must be carefully weighed against the increased risk of cancer death.

Patients should be appropriately counselled by experienced surgeons when considering partial cystectomy.

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Contributor Information and Disclosures
Author

E Jason Abel, MD Assistant Professor of Urologic Oncology, Department of Urology, University of Wisconsin Hospital and Clinics, University of Wisconsin School of Medicine and Public Health; Attending Urologist, William S Middleton Memorial Veterans Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Tracy Downs, MD Associate Professor of Urology, University of Wisconsin School of Medicine and Public Health

Tracy Downs, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Aaron M Potretzke, MD Resident Physician, Department of Urology, University of Wisconsin Hospital and Clinics

Aaron M Potretzke, MD is a member of the following medical societies: American Medical Association, Minnesota Medical Association

Disclosure: Nothing to disclose.

Kelvin Wong, MD Resident Physician, Department of Urology, University of Wisconsin Hospital and Clinics

Kelvin Wong, MD is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Jennifer E Heckman, MD, MPH Resident Physician, Department of Urology, University of Wisconsin Hospital and Clinics

Jennifer E Heckman, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society, Society of Women in Urology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American Urogynecologic Society, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received grant/research funds from Uroplasty for none; Partner received honoraria from Allergan for speaking and teaching.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Martin I Resnick, MD; Jason T Jankowski, MD; Edward E Cherullo, MD; Matthew L Steinway, MD; and Adrian H Feng, MD, to the development and writing of this article.

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Papillary bladder tumors such as this one are typically of low stage and grade (Ta-G1). Courtesy of Abbott and Vysis Inc.
Gross anatomy of the bladder.
Table 1. Proportion of Patients With Bladder Cancer Treated With Partial Cystectomy
Source Total Patients With Bladder Cancer Patients Treated With Partial Cystectomy (%)
Utz et al (1973) 3454 199 (5.8)
Brannan et al (1978) 551 49 (7.1)
Faysal and Freiha (1979) 859 117 (13.6)
Merrell et al (1979) 585 54 (9.2)
Ojeda and Johnson (1983) 397 23 (5.8)
Jardin and Vallencien (1984) 475 90 (18.9)
Hayter et al (2000) 20,822 729 (3.5)
Holzbeierlein et al (2004) 935 58 (6.2)
Table 2. Options Other than Partial Cystectomy
Study Number of Patients Induction Therapy % Complete Response Consolidation Therapy % Overall Survival (years) % Overall Survival with Bladder Intact (years)
Housset et al 120 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil 77 Bifractionated XRT + concurrent 5-fluorouracil + cisplatin 63 (5)  



...



Sauer et al 184 45-54 Gy XRT + concurrent cisplatin or carboplatin 80 None 56 (5) 41 (5)
Fellin et al 56 2 cycles MCVa, 40 Gy XRT + concurrent cisplatin 50 24 Gy XRT + concurrent cisplatin 55 (5) 41 (5)
Tester et al 49 40 Gy XRT + concurrent cisplatin 66 24 Gy XRT + concurrent cisplatin 60 (4) 42 (4)
Tester et al 91 2 cycles MCV, 39.6 Gy XRT + concurrent cisplatin 75 25.2 Gy XRT + concurrent cisplatin 62 (4) 44 (4)
Shipley et al 61 2 cycles MCVa, 39.6 Gy XRT + concurrent cisplatin 61 25.2 Gy XRT + concurrent cisplatin 48 (5) 36 (5)
Shipley et al 62 39.6 Gy XRT + concurrent cisplatin 55 25.2 Gy XRT + concurrent cisplatin 49 (5) 40 (5)
Kachnic et al 106 2 cycles MCV, 40 Gy XRT + concurrent cisplatin 66 24.8 Gy XRT + concurrent cisplatin 52 (5) 43 (5)
Zietman et al 18 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil 78 Bifractionated XRT + concurrent cisplatin + 5-fluorouracil + 3 cycles MCV 83 (3) 78 (3)
Table 3. Various Studies and Their Corresponding Recurrence Rates
Studies Recurrence rates
Resnick and O'Connor (1973) 76%
Evans and Texter (1975) 40%
Novick and Stewart (1976) 50%
Peress et al (1977) 54%
Cummings et al (1978) 49%
Schoborg et al (1979) 70%
Faysal and Freiha (1979) 78%
Jardin and Vallencien (1984) 78%
Lindahl et al (1984) 58%
Kaneti (1986) 38%
Dandekar et al (1995) 43%
Holzbeierlein et al (2004) 19%
Kassouf et al (2006) 49%
Knoedler et al (2012) 43%
Table 4. Survival Rates by Tumor Grade
Source Five-year Survival (%) Ten-year Survival (%)
Grade I Grade II Grade III/IV Grade I Grade II Grade III/IV
Magri (1962)  



88



33 34 - - -
Utz et al (1973) 100 48 39 - - -
Novick and Stewart (1976) 100 75 40 0 67 8
Brannan et al (1978) 50 62 55 50 33 30
Cummings et al (1978) 100 96 32 - - -
Schoborg et al (1979) 75 62 26 50 28 4
Faysal and Freiha (1979) 100 53 30 25 20 8
Merrell et al (1979) 78 56 22 83 32 0
Kaneti (1986) 75 46 46 - - -
Dandekar et al (1995) 100 94.4 53.5 - - -
Table 5. Survival Rates by Tumor Stage
Source Five-year Survival (%) Ten-year Survival (%)
T0 T1 T2 T3 T4 Overall T0 T1 T2 T3 T4 Overall
Magri (1962) - 80 38 26 0 42 - - - - - -
Long et al (1962) 80 67 43 9 0 - - - - - - -
Cox et al (1969) - - 20 16 - - - - - - - -
Resnick and O'Connor (1978) 75 71 77 12.5 20 35 - - - - - -
Utz et al (1973) - 68 47 29 0 39 - - - - - -
Evans and Texter (1975) - 69 43 14 0 0 - - - - - 21
Novick and Stewart (1976) - 67 53 20 - 46 - 67 44 - - 36
Brannan et al (1978) 100 69 54 33 0 57 - 31 36 11 - 32
Cummings et al (1978) - 79 80 6 - 60 - - - - - -
Schoborg et al (1979) 69 69 29 12 100 43 - 37 0 0 0 12
Faysal and Freiha (1979) 75 58 29 7 0 40 21 15 13 7 0 9
Merrell et al (1979) 100 100 67 25 - 48 - 100 33 0 0 32
Lindahl et al (1984) - 59 38 - - 42 - 48 25 - 0 38
Kaneti (1986) - 68 40 33 0 48 - - - - - -
Smaldone et al (2008) - - - - - 70            
a Stage T3a/T3b
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