Are there any metastases to the chest in non-muscle-invasive bladder cancer patients on follow-up computed tomography?

The purpose of the study was to retrospectively determine whether there are metastases to the chest in patients with primary non-muscle-invasive urothelial carcinoma in the bladder on the follow-up computed tomography (CT).

We analyzed 328 patients with follow-up chest CT for urothelial carcinoma of the bladder diagnosed between January 2004 and September 2013. We divided patients into four groups: Ta (n = 74), T1 (n = 78), carcinoma in situ (CIS, n = 25), and ≥ T2 (n = 151). We used the chest CT to determine whether there were positive findings of metastasis. Univariate and multivariate analyses were achieved using categories of T stage, histological grade, multifocal lesions, and recurrence.

On univariate analysis, there were significant differences on T stage (p < 0.001) and histological grade (p = 0.001), and there was no significant difference on multifocal lesions (p = 0.11) and recurrence (p = 0.34). Positive findings of metastases were observed in 1.4% (1/74) of the Ta patients, 0% (0/78) of the T1 patients, 8.0% (2/25) of the patients with carcinoma in situ (CIS), and 27.2% (41/151) of the ≥ T2 patients (p < 0.001). On multivariate analysis, T staging was independent variable for positive findings of metastasis (Odds ratio; 2.84, 95% Confidence Interval; 1.65-4.89). In contrast, histological grade, multifocal lesions, and recurrence were not independent variables.

T stage would affect to metastasis to the chest. It might be appropriate to omit chest CT in patients with Ta or T1 without upstaging in the course of follow-up. We may suggest that the follow-up chest CT in patients with CIS.

International urology and nephrology. 2018 Aug 16 [Epub ahead of print]

Hiroshi Juri, Mitsuhiro Koyama, Haruhito Azuma, Yoshifumi Narumi

Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. ., Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan., Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.