Recurrence of high‐risk bladder cancer: A population‐based analysis

Abstract

Background Patients with bladder cancer are apt to develop multiple recurrences that require intervention. We examined the recurrence, progression and bladder cancer-related mortality rates in a cohort of individuals with high-grade non-muscle-invasive bladder cancer. Methods Using linked SEER-Medicare data, we identified subjects with a diagnosis of high-grade, non-muscle-invasive disease in 1992–2002 and were followed until 2007. We then used multivariate competing-risks regression analyses to examine recurrence, progression, and bladder cancer-related mortality rates. Results Of 7,410 subjects, 2,897 (39.1%) experienced a recurrence without progression, 2,449 (33.0%) experienced disease progression, of whom 981 succumbed to bladder cancer. Using competing-risks regression analysis, we found the 10-year recurrence, progression, and bladder cancer-related mortality rates to be 74.3%, 33.3%, and 12.3%, respectively. Stage T1 was the only variable associated with a higher rate of recurrence. Women, black race, undifferentiated grade, stage Tis and T1 were associated with a higher risk of progression and mortality. Advanced age (≥70) was associated with a higher risk of bladder cancer-related mortality. Conclusions Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within ten years of their diagnosis. Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer. Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first two years of diagnosis warrants an intense surveillance schedule.

Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

“…Another potential issue is that we included patients without recurrence for 36 months, and defined recurrence as receipt of a new chemotherapy regimen. Despite the fact that we used methods similar to those used in other studies to define recurrence, [40][41][42][43] we acknowledge that this approach may not capture patients who chose not to receive chemotherapy, as suggested by a recent paper. 44 We do not feel this would have had a large impact on our sample population, as we required that patients survive 3 years, which would have been less likely without chemotherapy.…”

Genome-Wide Association Study of Bladder Cancer in a Chinese Cohort Reveals a New Susceptibility Locus at 5q12.3

“…A high rate of recurrence is a major medical problem in nonmuscle invasive bladder cancers, and up to 75% of these cases exhibit at least one episode of recurrence after the initial treatment (38,39). Multiple molecular markers have been implicated in bladder cancer recurrence, including loci identified from a GWAS (40).…”

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

“…Increased risk of progression and bladder cancer death have been found in a SEER review of Medicare claims [39] (HR 1.23, 95% CI 1.12-1.36 and HR 1.55, 95% CI 1.34-1.81 for progression and bladder cancer death, respectively), and at a single English institution (HR 1.37, 95% CI 1.03-1.83, p = 0.03) for progression [40] and 5 years cancer-specific mortality 32% women versus 22% men, p < 0.001 [32]. A retrospective analysis of Spanish patients by Palou et al [41] following single TUR and induction BCG found a non-significant trend toward increased risk of progression in women (HR 2.41, 95% CI 0.96-6.04, p = 0.06) an increased cancer-specific mortality rate (p = 0.004, HR 3.53) as well as a significant association with a shorter time to recurrence (HR 2.30, 95% CI 1.25-4.22, p = 0.008).…”