"Very-low-risk" bladder tumours- a new entity?

To evaluate the homogeneity of the "low-risk" bladder cancer group in an attempt to optimize follow-up protocols.

Between June 1998 and December 2008, 211 patients (mean age of 66.7 years, S. D 12.8) underwent transurethral resection of low-risk bladder cancer. Post-operative follow-up included cystoscopy at 3 and 12 months after surgery and then annually for a total of 5 years and then annual ultrasonography indefinitely.

After a median follow-up of 10 years, 65 patients (30.7%) developed tumour recurrence and 3 (1.4%) stage-progression. Eighty-four patients (40%) had tumours ≤ 1 cm. These patients were significantly younger than patients with 1.1-3 cm tumours (64.6 years Vs. 68.3, p=0.03). Their 5-year recurrence-free survival rate was significantly higher (92% compared to 70% in patients with larger tumours, p=0.0009). Median time to recurrence was 5.7 years in patients with smaller tumours and 3.6 years in patients with larger tumours (p=0.03). Only 43.7% of the recurrences in patients with small tumours occurred within 5 years, compared to 75.5% of the larger tumours.

Patients with low-risk bladder cancer make an inhomogeneous group. They can be stratified according to tumour size. Patients with tumours smaller than 1 cm are younger, have lower risk of tumour recurrence and most of their recurrences arise beyond the recommended 5-year surveillance period. It seems that these patients can be classified separately to a "very-low-risk" group. Follow-up in these cases can be based on prolonged non-invasive evaluations. This article is protected by copyright. All rights reserved.

BJU international. 2017 Dec 23 [Epub ahead of print]

Ofer N Gofrit, Dov Pode, Galina Pizov, Mordechai Duvdevani, Ezekiel H Landau, Guy Hidas, Vladimir Yutkin

From the Departments of Urology (ONG, MD, EHL, GH, VY) and Pathology (GP) Hadassah Hebrew University Hospital, Jerusalem, Israel.