Cancer-Specific Survival of Patients with Non-Muscle-Invasive Bladder Cancer: A Population-Based Analysis

Abstract

Background and Purpose Non-muscle-invasive bladder cancer (NMIBC) constitutes a heterogeneous group of tumors with different prognoses. This population-based study aimed to report real-world cancer-specific survival (CSS) of NMIBC and create a prognostic nomogram based on the identified risk factors. Methods The Surveillance, Epidemiology, and End Results database was searched for patients diagnosed with NMIBC from 2004 to 2015, who underwent transurethral resection of the bladder tumor. The dataset was divided into development and validation cohorts. Factors associated with CSS were identified using Cox proportional hazards and used to develop a prognostic nomogram. Results In total, 98,238 patients with NMIBC were included. At the median follow-up of 124 months (IQR 81–157 months), cancer-specific mortality (CSM) was highest for T1HG (19.52%), followed by Tis (15.56%), similar for T1LG and TaHG (10.88% and 9.23%, respectively), and lowest for TaLG (3.76%). Multivariable Cox regression for CSS prediction was utilized to develop a nomogram including the following risk factors: tumor T category and grade, age, tumor size and location, histology type, primary character, race, income, and marital status. In the validation cohort, the model was characterized by an AUC of 0.824 and C-index that reached 0.795. Conclusions To conclude, NMIBC is associated with a significant risk of long-term CSM especially, but not only, in patients with T1HG. Rarely diagnosed TaHG and T1LG tumors should be regarded as high-risk due to approximately 10% CSM. T category, grading, and age remain the most powerful determinants of CSS in NMIBC, but sociodemographic factors might also influence its prognosis.

BCG and Alternative Therapies to BCG Therapy for Non-Muscle-Invasive Bladder Cancer

“…The study also uncovered that those with low-grade T1 and high-grade Ta staging also demonstrated a substantial 10% risk of cancerspecific mortality (CSM). These findings underscore the importance of recognizing the non-negligible risks associated with NMIBC, especially in cases involving specific staging characteristics [2].…”

Upper Urinary Tract Urothelial Cancer After Radical Cystectomy for Bladder Cancer: Survival Outcomes After Radical Nephroureterectomy

“… 18 Notably, the indications for RC in the NMIBC setting include BCG-unresponsive disease, tumors not amenable to complete transurethral resection, and selected cases of high- and very-high-risk tumors, which are at significant risk of cancer-specific mortality. 19 …”

The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer

“…The inadequate management of elderly individuals has also been observed in the context of urothelial bladder cancer research [ 25 ]. Several studies have reported an independent negative prognostic role of older age for CSS in various stages of urothelial cancer of the bladder and upper urinary tract [ 26 , 27 , 28 , 29 ]. A recent multicenter study has also shown that patients aged 70 and above undergoing RNU for UTUC had worse OS and CSS compared to younger individuals [ 29 ].…”