Treatment and survival in patients with recurrent high-risk non–muscle-invasive bladder cancer

Abstract

Background Multiple recurrences develop in patients with high-risk non–muscle-invasive bladder cancer. As neither the association of recurrences with survival nor the subsequent aggressive treatment in individuals with recurrent high-grade non–muscle-invasive bladder cancer has ever been quantified, we sought to determine whether the increasing number of recurrences is associated with higher subsequent treatment and mortality rates. Methods Using linked Surveillance, Epidemiology, and End Results–Medicare data, we identified subjects with recurrent high-grade, non–muscle-invasive disease diagnosed in 1992 to 2002 and followed up until 2007. Using competing-risks regression analyses, we quantified the incidence of radical cystectomy, radiotherapy, and systemic chemotherapy after each recurrence. We then performed a propensity-score adjusted competing-risks regression analysis to determine whether the increasing recurrences portend worse survival. Results Of 4,521 subjects, 2,694 (59.6%) had multiple recurrences within 2 years of diagnosis. Compared with patients who only had 1 recurrence, those with ≥4 recurrences were less likely to undergo radical cystectomy (hazard ratio [HR] = 0.73, 95% CI: 0.58–0.92), yet more likely to undergo radiotherapy (HR = 1.51, 95% CI: 1.23–1.85) and systemic chemotherapy (HR = 1.58, 95% CI: 1.15–2.18). For patients with ≥4 recurrences, only 25% were treated with curative intent. The 10-year cancer-specific mortality rates were 6.9%, 9.7%, 13.7%, and 15.7% for those with 1, 2, 3, and ≥4 recurrences, respectively. Conclusions Only 25% of patients with high-risk non–muscle-invasive bladder cancer who experienced recurrences at least 4 times underwent radical cystectomy or radiotherapy. Despite portending worse outcomes, increasing recurrences do not necessarily translate into higher treatment rates.

Association between Metabolic Syndrome and Recurrence of Nonmuscle Invasive Bladder Cancer following bacillus Calmette-Guérin Treatment

“…18 However, there continues to be an extensive divergence in the aggressive treatment of patients with bladder cancer. 19 Therefore, determining clinically useful predictors of response to BCG may help aid decisions to choose a definitive treatment and set appropriate expectations.…”

Association Between Number of Endoscopic Resections and Utilization of Bacillus Calmette-Guérin Therapy for Patients With High-Grade, Non–Muscle-Invasive Bladder Cancer

“…3 Consequently, many patients with disease recurrence are treated with endoscopic and intravesical therapy. We sought to evaluate the relationship between number of endoscopic resections and BCG use to understand how compliance and utilization may be optimized.…”

“…cystectomy, radiotherapy, or chemotherapy) after the first recurrence. 2,3 Several studies have demonstrated that patients with high-grade NMIBC who opt for more aggressive treatment, for example cystectomy, do so early usually after the first recurrence. 3 Consequently, a significant fraction of patients with recurrent, high-grade NMIBC are managed primarily with endoscopic and intravesical treatments.…”

Functional Genomics Identifies Multiple Clinically Actionable Resistance Mechanisms to CDK4/6 Inhibition in Bladder Cancer

“…Tumours that have invaded the detrusor muscle with stage T2 or above are considered as muscle-invasive bladder cancer (MIBC) and are more likely to metastasize to lymph nodes or other organs. Approximately 75% of newly diagnosed patients have non-muscle-invasive bladder cancer (NMIBC) with stage lower than T1 and 25% have MIBC or metastatic disease (Chamie et al, 2015).…”

“…The other research using a cohort of patients with metastatic urothelial cancer treated with a PD-1 inhibitor, nivolumab demonstrated that in patients with T-cell infiltrated tumors, higher EMT/stroma-related gene expression is associated with lower response rates and shorter progressionfree and overall survival (Wang et al, 2018). With more and more available sequencing data from clinic, especially patients with different treatment, we could predict personalized treatment based on exclusive genetic background of patients will be the future direction on treatment of bladder cancer (Chamie et al, 2015;Choi et al, 2014;Dadhania et al, 2016;Guo et al, 2016;Robertson et al, 2018).…”