Abstract
Background
International guidelines vary in terms of their definition and recommendation for management of low-risk non-muscle-invasive bladder cancer (LRNMIBC). The ideal management for this large subset of bladder cancer patient remains unclear.
Objective
To evaluate long-term outcomes of patients with LRNMIBC. As a secondary objective, to assess for intergroup heterogeneity in disease-specific outcomes between G1 and G2LG diseases.
Methods
A multi-centre, retrospective study of patients who met the 2015 NICE definition of LRNMIBC. Timeline of diagnosis ranged from 01/01/2012 to 30/06/2016.
Results
A total 390 patients had available follow-up data (G1: 142, G2LG: 249). Over a median follow-up time of 36 months (IQR 25–50), 29.2% of the patients developed a recurrence. G2LG patients were statistically more likely to develop a recurrence (G1: 26.8%, G2LG: 33.7%, p < 0.05). 51.8% of recurrences occurred after 1 year of surveillance. Progression to high-grade disease occurred in 1.8% (n = 7, G1: 3, G2LG: 4) and a further 1.0% (n = 4, G1:3, G2LG: 1) of patients developed muscle-invasive bladder cancer (MIBC).
Conclusion
The majority of recurrences occurred after 1 year of surveillance. The risk of disease progression was low; however, this was observed in a cohort of patients with regular cystoscopic follow-up. The risk may be higher if patients were pre-maturely discharged. If a 5-year surveillance programme were to be followed, 96.5% of recurrences would be captured. Lastly, there appears to be intergroup heterogeneity within LRNMIBC with G2LG patients having a statistically higher risk of recurrence compared to G1.
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References
Stewart BW, Wild CP (2014) 2014 World Cancer Report. International Agency for Research on Cancer, Lyon, France
Sievert KD, Amend B, Nagele U et al (2009) Economic aspects of bladder cancer: what are the benefits and costs? World J Urol 27:295
Sangar VK, Ragavan N, Matanhelia SS et al (2005) The economic consequences of prostate and bladder cancer in the UK. BJU Int 95:59
National Institute for Health and Care Excellence (NICE). Bladder cancer: diagnosis and management. February 2015 https://www.nice.org.uk/guidance/ng2/evidence. Accessed December 2020
Babjuk M, Böhle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461
Chang SS, Boorjian SA, Chou R et al. Diagnosis and Treatment of Non- Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline, 2016. Available at URL: http://www.auanet.org/guidelines/non-muscle-invasive-bladder-cancer. Accessed December 2020
Sylvester RJ, van der Meijden AP, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466
Almeida GL, Busato WF Jr, Ribas CM et al (2016) External validation of EORTC risk scores to predict recurrence after transurethral resection of brazilian patients with non -muscle invasive bladder cancer stages Ta and T1. Int Braz J Urol 42:932–941
Leo MC, McMullen CK, O’Keeffe-Rosetti M et al (2020) External validation of the EORTC and NCCN bladder cancer recurrence and progression risk calculators in a U.S. community-based health system. Urol Oncol 39:21–39
Soukup V, Čapoun O, Cohen D et al (2020) Risk stratification tools and prognostic models in non-muscle-invasive bladder cancer: a critical assessment from the European association of urology non-muscle-invasive bladder cancer guidelines panel. Eur Urol Focus 15:479–489
Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J et al (2000) Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol 164:680–684
Rieken M, Xylinas E, Kluth L et al (2014) Long-term cancer-specific outcomes of TaG1 urothelial carcinoma of the bladder. Eur Urol 65:201–209
Linton KD, Rosario DJ, Thomas F et al (2013) Disease specific mortality in patients with low risk bladder cancer and the impact of cystoscopic surveillance. J Urol 189:828–833
Holmang S, Hedelin H, Anderstrom C et al (1999) Recurrence and progression in low grade papillary urothelial tumors. J Urol 162:702–707
Millán-Rodríguez F, Chéchile-Toniolo G, Salvador-Bayarri J et al (2000) Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol 164:680–684
Hurle R, Colombo P, Lazzeri M et al (2018) Pathological outcomes for patients who failed to remain under active surveillance for low-risk non-muscle-invasive bladder cancer: update and results from the bladder cancer italian active surveillance project. Eur Urol Oncol 1:437–442
Biardeau X, Lam O, Ba V, Campeau L et al (2017) Prospective evaluation of anxiety, pain, and embarrassment associated with cystoscopy and urodynamic testing in clinical practice. Can Urol Assoc J 11:104–110
Stav K, Leibovici D, Goren E et al (2004) Adverse effects of cystoscopy and its impact on patients’ quality of life and sexual performance. Isr Med Assoc J 6:474–478
Schroeck FR, Lynch KE, Li Z et al (2019) The impact of frequent cystoscopy on surgical care and cancer outcomes among patients with low-risk, non-muscle-invasive bladder cancer. Cancer 125:3147–3154
Gofrit ON, Pode D, Pizov G et al (2018) ‘Very-low-risk’ bladder tumours—a new entity? BJU Int 121:627–631
Lee A, Lee HJ, Huang HH et al (2019) Low-risk non-muscle-invasive bladder cancer: further prognostic stratification into the “very-low-risk” group based on tumor size. Int J Urol 26:481–486
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Jaffer, A., Lee, M., Khalil, O. et al. The natural history of low-risk non-muscle-invasive bladder cancer: a collaborative multi-centre study. Int Urol Nephrol 54, 2175–2180 (2022). https://doi.org/10.1007/s11255-022-03264-8
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DOI: https://doi.org/10.1007/s11255-022-03264-8