Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

Abstract

PurposeTo identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC).Materials and MethodsData were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression.ResultsWith a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy.ConclusionA preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Selected protein expression in a new prognostic model for patients with non-muscle-invasive bladder cancer

“…Attempts have been made by many researchers to improve the algorithms developed by the EORTC. Some authors have focused on the preparation of prognostic models for specific groups of patients, while others have attempted to determine the probability of tumor recurrence by evaluating gene polymorphisms, inflammation, or the presence of tumor markers in urine (Ieda et al 2016;Kim et al 2016;Maturana et al 2016;Chen et al 2012;Cui et al 2017;Todenhöfer et al 2014;Lammers et al 2016). The possibility of improving the accuracy of these algorithms by means of immunohistochemistry was also analyzed (Ding et al 2014;Passoni et al 2016).…”

Dose, duration and strain of bacillus Calmette–Guerin in the treatment of nonmuscle invasive bladder cancer

“…Second, unknown or uncontrolled variables that could not be clearly identified in the included trials might have affected the results of this analysis. Interinstitutional variation of TURBT techniques (ie, muscle layer resection, restaging TURBT), primary tumor size, and preoperative positive urine cytology, which were suggested as the important prognostic factors of NMIBC in previous studies, [ 41 – 45 ] could not be adjusted through a multivariable analysis along with BCG. Third, the results of this systematic review and meta-analysis were based on unadjusted estimates, because some studies did not provide detailed information (Table 1 ).…”

Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

“…Moreover, other studies showed that positive preoperative VUC is associated with disease recurrence and cancer-speci c mortality after transurethral resection of bladder tumors [26][27][28]. The loss of intercellular adhesion is one of the critical biological processes for cancer cells acquiring invasive and metastatic potential, and thus positive VUC could indicate the fragility of intercellular adhesion and re ect the aggressiveness of bladder cancer [26].…”