The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer

Abstract

OBJECTIVE:We aimed to investigate the impact of tumor necrosis in non-muscle invasive bladder cancer on patients' recurrence and progression rates and survival outcomes. METHODS: This study was conducted retrospectively in a single tertiary center in Turkey. Medical records of patients who underwent transurethral resection of the bladder tumor between January 2016 and January 2021 were reviewed. Patients with pTa and pT1 non-muscle invasive bladder cancer who had undergone complete resection were included in our study. All pathological specimens were reevaluated for the presence of tumor necrosis. RESULTS: A total of 287 patients (244 males and 43 females) were included in our study. Of them, 33 (11.5%) patients had tumor necrosis. The rates of multiple and large tumors (>3 cm) were higher in patients with tumor necrosis (p=0.002 and p<0.001, respectively). Tumor necrosis was associated with higher rates of pT1 diseases (p<0.001), high-grade tumors (p<0.001), and the presence of lymphovascular invasion (p=0.007). The mean recurrence-free survival of patients with tumor necrosis was 42.3 (4.6) months, and the recurrence-free survival of patients without tumor necrosis was 43.5 (1.8) months (p=0.720). The mean progression-free survival of patients with tumor necrosis was 43.1 (4.6) months, and the progressionfree survival of patients without tumor necrosis was 58.4 (0.9) months. In log-rank analysis, there was a statistically significant difference between patients with and without tumor necrosis in terms of progression-free survival (p<0.001). CONCLUSION: In this study, we demonstrated that patients with non-muscle invasive bladder cancer and tumor necrosis in pathological specimens have shorter progression-free survival and more adverse pathological features.

Comment on “The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer”

“…Second, the conclusion of this study cannot be considered definitive regarding the impact of tumor necrosis on the prognosis of non-muscle-invasive bladder cancer. While this study suggests that tumor necrosis was associated with cancer progression (p<0.001), as shown in Table 1, a subsequently more rigorous analysis using multivariate Cox regression has shown that there is no association between tumor necrosis and the recurrence (p>0.05) and progression (p>0.05) in patients with non-muscle-invasive bladder cancer, as described in Table 2 of this study 1 . Statistically, the evidence level of multivariate Cox regression analysis is higher than that of Kaplan-Meier analysis, because Cox regression analysis takes into account the influence of all confounding factors (such as age, gender, tumor number, and tumor size) while Kaplan-Meier analysis does not.…”

“…These findings suggest that BMI should be taken into account when assessing the risk of bladder cancer recurrence and developing personalized treatment plans for survivors with bladder cancer. Therefore, the absence of BMI data in this study 1 limits the ability to draw comprehensive conclusions about the prognostic impact of tumor necrosis in patients with non-muscle-invasive bladder cancer.…”

“…We read with great interest the article entitled “The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer 1 .” The study 1 aimed to investigate the predictive value of tumor necrosis in patients with non-muscle-invasive bladder cancer and its impact on disease progression and recurrence. The conclusion of this study stated that the presence of tumor necrosis is a significant predictor of disease progression (p=0.00) in patients with non-muscle-invasive bladder cancer, which highlights the importance of considering tumor necrosis as a prognostic factor in patients with non-muscle-invasive bladder cancer.…”