BACKGROUND: The treatment of high-risk non-muscle-invasive bladder cancer (BCa) is problematic given the variable natural history of the disease.
Few reports have compared outcomes for primary high-risk tumours with those that develop following previous BCas (relapses). The latter represent a self-selected cohort, having failed previous treatments.
OBJECTIVE: To compare outcomes in patients with primary, progressive, and recurrent high-risk non-muscle-invasive BCa.
DESIGN, SETTING, AND PARTICIPANTS: We identified all patients with primary and relapsing high-risk BCa tumours at our institution since 1994. Relapses were divided into progressive (previous low- or intermediate-risk disease) and recurrent (previous high-risk disease) cancers.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Relationships with outcome analysed using multivariable Cox regression and log-rank analysis.
RESULTS AND LIMITATIONS: We identified 699 primary, 110 progressive, and 494 recurrent high-risk BCa tumours in 809 patients (average follow-up: 59 mo [interquartile range: 6-190]). Muscle invasion occurred most commonly in recurrent (23%) tumours, when compared to progressive (20%) and primary (14.6%) cohorts (log rank p< 0.001). Disease-specific mortality (DSM) occurred more frequently in patients with recurrent (25.5%) and progressive (24.6%) tumours compared to primary disease (19.2%; log rank p=0.006). Other-cause mortality was similar in all groups (log rank p=0.57), and overall mortality was highest in the progressive cohort (62%) compared with the recurrent (58%) and primary groups (54%; log rank p< 0.001). In multivariable analysis, progression and DSM were predicted by tumour grouping (hazard ratio [HR]: >1.15; p< 0.026), stage (HR: >1.30; p< 0.001), and patient age and sex (HR: >1.03; p< 0.037). Carcinoma in situ was only predictive of outcome in primary tumors. Limitations include retrospective design and limited details regarding bacillus Camille-Guérin use.
CONCLUSIONS: Patients with relapsing, high-risk, BCa tumors have higher progression, DSM, and overall mortality rates than those with primary cancers. The use of bladder-sparing strategies in these patients should approached cautiously. Carcinoma in situ has little predicative role in relapsing, high-risk, BCa tumors.
Thomas F, Noon AP, Rubin N, Goepel JR, Catto JW. Are you the author?
The Academic Urology Unit and Institute for Cancer Studies, University of Sheffield, Sheffield, UK.
Reference: Eur Urol. 2012 Sep 5. pii: S0302-2838(12)01017-2.