[Infiltrating transitional cancer of the bladder (2). Prognostic value of the stage. Its influence on the therapeutic decision)].
The only reliable sign to give a prognosis is the anatomopathological stage (P or pT) obtained from the study of the cystectomy surgical piece: partial or total. Tumourless (P0) bladders conceal the inability to reach any certainty over the tumour's inexistance. Removal should not be considered as a success but an error. The fact that no tumour is found in the removed bladder does not guarantee that the patient will not eventually die of metastasis. A pT2 stage has a better prognosis than pT3a and both evolve better that either pT3b or pT4a and, therefore, their treatment and management may be different. Clinical stage (T) is not a reliable sign: the possibilities of over and undervaluation are very high. Subtraction of P from T cannot be maintained as an adequate sign to assess the action of the adjuvant therapy to surgery and should be excluded in order to delimit the action of the neo-adjuvant chemotherapy. Also, patients with pT2 and pT3a tumours should be excluded from these protocols since the possibilities that they may be removed during the evaluation R.T.U. are high.