Recurrence at Three Months and High-grade Recurrence as Prognostic Factor of Progression in Multivariate Analysis of T1G2 Bladder Tumors

Abstract

OBJECTIVESTo evaluate the risk factors for disease progression in the frequent subgroup of Stage T1G2 (World Health Organization 1973) bladder tumors using an analysis of a large cohort of patients with Stage T1G2 disease. METHODSA cohort of 616 patients with Stage T1G2 were treated with transurethral resection and random bladder biopsies. The mean follow-up was 4.2 years. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, association with carcinoma in situ (CIS), tumor size, tumor recurrence at 3 or 6 months, tumor grade, and association with CIS at first recurrence. The dependent variable was progression to muscleinvasive disease. RESULTSProgression to muscle-invasive disease was identified in 28 of the 616 patients (4.5%). On multivariate analysis, when considering recurrence at 3 months, this factor was the principal prognostic factor, with a relative risk of 4.0 (95% confidence interval 1.2-13.3), followed by the presence of high-grade disease or CIS at first recurrence (relative risk 2.8, 95% confidence interval 1.3-5.8) and CIS associated with the primary tumor (relative risk 1.8, 95% confidence interval 1.1-2.9). When considering recurrence at 6 months, more prognostic factors were involved for progression, including as multiple tumors, CIS associated with the primary tumor, recurrence at 6 months, and the presence of high-grade disease or CIS at the first recurrence. CONCLUSIONSIn primary urothelial T1G2 bladder cancer, recurrence at 3 months was the main prognostic factor related to progression. Additional factors were the association of CIS with the primary tumor and the presence of high-grade disease and/or CIS at first recurrence. UROLOGY 73: 1313UROLOGY 73: -1317UROLOGY 73: , 2009

The value of EORTC risk tables in evaluating recurrent non–muscle–invasive bladder cancer in everyday practice

“…The result of the first control cystoscopy 3 months after TURBT is a very important prognostic factor for recurrence and progression [3–5, 12]. Our statistics confirmed the results of previous studies indicating an important prognostic value of the first cystoscopy after endoscopic treatment.…”

EAU Guidelines on Non–Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016

“…In patients with high-risk disease, the tumour stage at the time of the second TURB is an unfavourable prognostic factor [54] O G Y X X X ( 2 0 1 6 ) X X X -X X X prognosis in concurrent CIS and T1 tumours compared with primary CIS [63], in extended CIS [64], and in CIS in the prostatic urethra [40] (LE: 3). The response to intravesical treatment with BCG or chemotherapy is an important prognostic factor for subsequent progression and death caused by BCa [57,61]. Approximately 10-20% of complete responders eventually progress to muscle-invasive disease, compared with 66% of nonresponders [65] (LE: 2a).…”

“…Some authors have even defended temporary surveillance in selected cases [121] (LE: 3). The first cystoscopy after TURB at 3 mo is an important prognostic indicator for recurrence and progression [61,65,122,123] (LE: 1a); therefore, the first cystoscopy should always be performed 3 mo after TURB in all patients with TaT1 tumours and CIS.…”

CUA guidelines on the management of non-muscle invasive bladder cancer

“…74 Follow-up All patients are recommended to undergo a cystoscopy at 3 months following TURBT, as cystoscopic findings at 3 months have been shown to be a prognostic factor of recurrence and progression of disease (Grade A recommendation). 24,[78][79][80][81][82] Prospective studies to better refine the surveillance schedule are sorely needed. Although there is no consensus for surveillance strategies, our general recommendation is to perform a follow-up cystoscopy with urine cytology (or other urine marker) every 3 to 4 months for 2 years, then every 6 months for years 3 and 4, then yearly thereafter (Grade B recommendation).…”