ORLANDO, FL USA (UroToday.com) - Multiple bladder cancer recurrences are more likely to occur in patients with high-risk disease. Association between recurrences and aggressive treatment in patients who have recurrent high-grade bladder cancer has not be reported. Karim Chamie and colleagues’ objectives were to determine if increase in number of recurrences correlated with higher treatment rates.
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The authors used the SEER-Medicare database to identify patients with recurrent high-grade disease diagnosed from 1992-2002 and followed until 2007. They then quantified the incidence of treatments including radical cystectomy, radiotherapy, and systemic chemotherapy after each recurrence.
Of the 4 521 patients identified by the authors, 2 694 of them had more than one recurrence after diagnosis in the first 2 years. Patients with higher number of recurrences (> 4) were less likely to undergo radical cystectomy and more likely to undergo radiotherapy and systemic chemotherapy. In addition, they reported that patients with multiple recurrences had a lower rate of treatment with goals of cure. Ten year cancer specific mortality rates were 6.9%, 9.7%, 13.7%, and 15.7% for those with 1, 2, 3, and > 4 recurrences
The authors concluded that only 25% of patients with high-risk bladder carcinoma and multiple recurrences will undergo intended curative treatment. They also concluded that the treatment course of the patient does not appear to change, regardless of the number of recurrences the patient has. The findings have great clinical implications as mortality rates increase with higher number of recurrences. As the percentage of patients undergoing treatment remains the same with multiple recurrences, patients should get the results of the study in a clear way in order to make better-informed decisions.
Presented by Eric Ballon Landa, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Los Angeles, CA USA
Written by Garen Abedi, MD, University of California (Irvine), and medical writer for UroToday.com