Multiple recurrences and risk of disease progression in patients with primary low-grade (TaG1) non–muscle-invasive bladder cancer and with low and intermediate EORTC-risk score

Abstract

Aim To assess the prognostic value of multiple recurrences on the risk of progression in a large cohort of TaG1 bladder cancer of low and intermediate risk based on the EORTC score and to evaluate prognostic factors of multiple recurrences. Materials and methods We retrospectively analyzed a French cohort of 470 patients with primary TaG1 bladder cancer diagnosed between 1986 and 2010 and followed until 2012. They were classified at low and intermediate risk using the EORTC risk score. Associations between the number of recurrences and the risk of progression to high grade Ta/T1 bladder cancer and progression to muscle-invasive disease were assessed. The characteristics of recurrences, as occurrence time or localization, and risk of other recurrences were evaluated. Results Out of 470 patients, 251 had recurrence, 34 progressed to high grade Ta/T1 and 17 to muscle-invasive disease, including 4 who had non muscle-invasive progression first. The median follow-up was 7.2 years (interquartile range: 4.2–10.9). In half the progressions, no previous recurrence was observed. No association between the number of recurrences and the risk of progression was detected. Even after 5 years free of event, patients had a 15% risk of recurrence. History of two or more recurrences increased by 4.5 the risk of subsequent recurrence. Time between two recurrences inferior to six months and multifocal localization increased the risk of recurrence. Conclusion Surveillance of patients with TaG1 should be continued beyond 5 years of follow-up. However, cystoscopy exams could be spaced after 5 years. Multiple TaG1 recurrences did not appear to be prognostic for disease progression, but increased significantly the risk of subsequent recurrences. Short time between two recurrences and multifocal localization may serve to adapt monitoring of patients with TaG1 Bladder cancer.

Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes

“…Small, papillary tumors (< 3 cm) when resected are typically low-grade, low-risk, nonmuscle invasive bladder cancer (NMIBC). These are associated with frequent recurrences but very low risk of progression to higher stage [20] . Very small papillary tumors (<1 cm), can be safely fulgurated in the office setting.…”

Photodynamic Diagnosis-Assisted Transurethral Resection Using Oral 5-Aminolevulinic Acid Decreases the Risk of Repeated Recurrence in Non-Muscle-Invasive Bladder Cancer: A Cumulative Incidence Analysis by the Person-Time Method

“…However, patients can suffer from repeated same events in some types of disease, such as cardiovascular events [ 14 ], biliary colic due to gallbladder stone [ 15 ], urinary symptoms after radiotherapy in prostate cancer [ 16 ], and bladder recurrence of NMIBC [ 17 , 18 ]. Simon et al reported that repeated (two or more) recurrences of TaG1 tumors in patients with primary TaG1 was not associated with disease progression to high-grade Ta/T1 or muscle-invasive disease but increased the risk of subsequent recurrences [ 18 ]. Thus, more effort should be made to investigate the natural history of repeated recurrence after initial treatment and to decrease the risk of repeated recurrence.…”

“…Thus, more effort should be made to investigate the natural history of repeated recurrence after initial treatment and to decrease the risk of repeated recurrence. Previous studies have applied the extended Cox proportional hazards mode or multiple-event and event-count models to account for repeated events [ 17 , 18 ]. However, these statistical methods are considered too complicated to apply to our clinical practice.…”

On the Origin of Carcinoma

“…Therefore, several studies suggest that most of the beneficial effect of cancer therapy is attributed to the removal of tumor burden 269,271 . Although the 5-year relative survival rate of patients diagnosed and treated with lowgrade carcinomas is greater than 90%, they eventually progress to high-grade carcinomas and die from causes associated with cancer 37,272 . The invasive metastatic cancers are responsible for 90% of cancer mortality [5][6][7][8] and the only therapeutic option at this stage, due to relapses or tumor progression during treatment is palliative systemic therapy.…”