Recurrence and Progression Free Survival of Intermediate Risk Non-Muscle Invasive Bladder Cancer: The impact of Conditional Evaluation and Sub-Classification.

To assess the change in rates of recurrence-free survival (RFS) and progression-free survival (PFS) based on duration of survival without recurrence or progression among patients with intermediate-risk (IR) non-muscle invasive bladder cancer (NMIBC), and to examine predictive factors of recurrence at different time points, we examined conditional RFS and PFS.

A cohort of 602 patients treated with transurethral resection of bladder tumor (TURBT) and histopathologically diagnosed with IR NMIBC were included in this retrospective study.

The conditional RFS rate at 1, 2, 3, 4 and 5 years improved with increased duration of recurrence-free survival, however, the conditional PFS rate did not improve over time. Multivariable analyses showed that recurrent tumor, multiple tumors, tumor size (>3cm), immediate postoperative instillation of chemotherapy (IPIC), and administration of BCG were independent predictive factors for recurrence at baseline. The predictive ability of these factors disappeared with increasing recurrence-free survivorship. Sub-classification of these IR NMIBC patients into three groups using clinico-pathological factors (recurrent tumor, multiple tumors, tumor size) demonstrated that the high-IR group (2 factors) had significantly worse RFS than the intermediate (1 factor, p<0.001) and low-IR groups (0 factor, p=0.005) at baseline. This sub-classification stratified conditional risk of RFS also at 1, 3 and 5-year, which provides the basis for distinct surveillance protocols among patients with IR NMIBC.

Conditional survival analyses of patients with IR NMIBC demonstrate that RFS changes overtime, while PFS does not change. These data support distinct surveillance protocols based on the sub-classification of IR NMIBC.

BJU international. 2020 Aug 17 [Epub ahead of print]

Yuki Kohada, Tetsutaro Hayashi, Ryan S Hsi, Kazuma Yukihiro, Kazuhiro Sentani, Keisuke Goto, Shogo Inoue, Shinya Ohara, Jun Teishima, Mitsuru Kajiwara, Takashi Nishisaka, Wataru Yasui, Peter C Black, Akio Matsubara

Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan., Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan., Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Molecular Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan., Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan., The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.