Active surveillance for low-risk Non-Muscle Invasive Bladder Cancer (NMIBC): mid-term results from a Bladder cancer Italian Active Surveillance (BIAS) project

To report the oncologic safety and the risk of progression for patients with NMIBC included in an active surveillance (AS) program after the diagnosis of recurrence.

This is a prospective study enrolling patients with history of pathologically confirmed LG pTa-pT1a Non-Muscle Invasive Bladder Cancer (NMIBC) and diagnosed with a tumour recurrence. Inclusion criteria consisted of negative urine cytology, presence of ≤ 5 NMIBCs with a diameter ≤ 10 mm, absence of carcinoma in situ (CIS) or persistent gross haematuria. The primary outcome of interest was adherence to AS. Need to proceed with treatment was defined as progression in number/dimension/positive cytology/symptoms (gross haematuria persistent) or any further intervention (resection or electro-fulguration). Finally, we assessed the up-grading and up-staging when transurethral resection of bladder tumour (TURBT) was performed.

The study population consisted of 55 patients with a previous diagnosis of NMIBC (70 active surveillance events) prospectively recruited since 2008. The mean patient age was 69.8 years. Median follow-up was 53 months. The median time patients remained under AS was 12.5 months. A disease progression was observed in 28 patients (51%). No patient experienced progression to muscle-invasive disease. Fifteen patients (27.3%) showed an increase in the number and/or size of the tumour, 9 (16,4%) suffered from hematuria and 4 (7.3%) had a positive cytology. Only 5 (9%) patients in the whole series experienced progression to a high- grade tumour (G3) or presented with associated CIS. The overall adherence to the follow-up schedule was 95%.

Our data showed that an AS protocol for NMIBC could be a reasonable option in a selected group of patients with small, recurrent cancers. This article is protected by copyright. All rights reserved.

BJU international. 2016 May 21 [Epub ahead of print]

Rodolfo Hurle, Luisa Pasini, Massimo Lazzeri, Piergiuseppe Colombo, NicolòMaria Buffi, Giovanni Lughezzani, Paolo Casale, Emanuela Morenghi, Roberto Peschechera, Silvia Zandegiacomo, Alessio Benetti, Alberto Saita, Pasquale Cardone, Giorgio Guazzoni

Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Biostatistic Unit, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano Milan, Italy.

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