Tuesday, October 14, 2014

Historical Contribution: 1952, Jewett, 5-year survival for bladder cancer


1952
Jewett HJ. Infiltrating Carcinoma of the Bladder; relation of early diagnosis to five-year suvival rate after complete extirpation. J Am Med Assoc. 1952. 148(3):187-9.

 

Hugh J. Jewett, MD
In 1946, Dr. Hugh Jewett wrote the first manuscript detailing the clinical staging of infiltrative bladder cancer. In this 1952 follow-up, Dr. Jewett details the outcomes of patients undergoing radical and partial cystectomy for invasive bladder cancers. Interestingly, radical cystectomy (including lymphatic resection) or exenteration were sparsely used due to the high mortality and postoperative disability with each procedure.

In total, 80 patients underwent extirpative surgery: 39 simple cystectomy and 41 partial cystectomy.

  • For the 19 patients with tumors infiltrating less than halfway through the muscularis, 14 (74%) lived 5-14 years. 
    •  Only 10% had extension of tumor beyond the bladder. 
    •  37% were highly-malignant (high-grade).
  • Only 2 patients (3%) with deeply invading tumors survived 5 years. 
    •  85% of these patients had evidence of extension of their disease. 
    •  54% were highly-malignant.

Jewett astutely noted that invasive tumors were more often high-grade, but that stage (invasion) was more important in determining outcome than grade.

Interestingly, cystoscopy was part of the diagnostic algorithm for voiding symptoms but not for resection or staging of bladder tumors. Most patient in this series presented with hematuria or irritative voiding symptoms. Hematuria was the overwhelmingly present symptom, with gross hematuria present in 65 patients and microscopic hematuria in another 7 cases. Jewett attempted to correlate the temporality and severity of symptoms with stage of disease. He found that invasive tumors trended to having a longer duration of symptoms – suggesting that bladder cancer may progress from more superficial to invasive disease with time.




In conclusion, Jewett urged that:

"The reasonably good prognosis associated with superficial tumors, in contrast to the very poor prognosis afforded by deep tumors, should emphasize to the general public, the general practitioner, and the specialist the vital importance to the patient of immediate evaluation of the cause of hematuria or vesical irritability."

 

To read the entire manuscript: follow the link above, visit the Centennial Website or click here.


 

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 

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