Natural History of Multiple Recurrences in Intermediate-Risk Non-Muscle Invasive Bladder Cancer: Lessons From a Prospective Cohort

Sharma, Vidit; Chamie, Karim; Schoenberg, Mark; Lee, Valerie S.; Fero, Katherine E.; Lec, Patrick M; Munneke, Julie R.; Aaronson, David S.; Kushi, Lawrence H.; Quesenberry, Charles P.; Tang, Li; Kwan, Marilyn L.

doi:10.1016/j.urology.2022.12.009

Cited by 3 publications

(2 citation statements)

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“…15,16 Additionally, patients usually are selected who have a negative urinary cytology and absence of previous high-grade NMIBC and, of course, who are willing to adhere to an AS program. 11 Previous reports suggest that grade and stage progression in LG Ta patients occurs in only 2.5% of patients. 17 In the current study, the upgrading rate was 6% while the upstaging rate was 3%.…”

Section: Discussionmentioning

confidence: 98%

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International Bladder Cancer Group Intermediate-risk Nonmuscle-invasive Bladder Cancer Scoring System Predicts Outcomes of Patients on Active Surveillance

et al. 2023

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Study Need and Importance: Active surveillance (AS) for nonmuscle-invasive bladder cancer (NMIBC) is an underutilized concept for recurrent low-grade (LG) Ta/T1 NMIBC patients. Preserving patients' quality of life by minimizing surgical intervention is important, but we must also ensure this does not cause harm. Towards this end, there are no good recommendations on how to best select these patients for AS. What We Found: We utilized a prospective patient cohort (Bladder Cancer Italian Active Surveillance) of recurrent LG Ta/T1 NMIBC patients managed with AS with the following characteristics: 5 apparent LG NMIBC, tumor diameter 1 cm, no gross hematuria, and negative urinary cytology. Subsequent transurethral resection of bladder tumor (TURBT) was offered to patients who no longer met the inclusion criteria/patient choice. We then evaluated the ability of the International Bladder Cancer Group (IBCG) intermediate-risk (IR)-NMIBC scoring system to predict receipt of subsequent TURBT. Utilizing 163 patients with LG Ta/T1 NMIBC with a median follow-up of 33 months, multivariable Cox regression suggests that the IBCG IR-NMIBC scoring system was associated with subsequent TURBT (1-2 risk factors [HR: 1.66, 95% CI: 0.96-2.90, P [ .072], 3 risk factors [HR: 3.21, 95% CI: 1.70-6.09, P < .001]) after adjusting for age, T-stage, and sex (see Figure ). Limitations: The IBCG IR-NMIBC scoring system was applied retrospectively. Not all patients in the

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Section: Discussionmentioning

confidence: 98%

“…11 Previous reports suggest that grade and stage progression in LG Ta patients occurs in only 2.5% of patients. 17 In the current study, the upgrading rate was 6% while the upstaging rate was 3%. No patient developed MIBC.…”

Section: Discussionmentioning

confidence: 98%

International Bladder Cancer Group Intermediate-risk Nonmuscle-invasive Bladder Cancer Scoring System Predicts Outcomes of Patients on Active Surveillance

et al. 2023

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Recurrence patterns in a large contemporary cohort of patients with non-muscle invasive bladder cancer

Hof,

Kiemeney,

Aben

et al. 2024

Preprint

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Background and Objective: Patients with non-muscle invasive bladder cancer (NMIBC) frequently experience recurrences, yet, the timing and characteristics of subsequent recurrences are understudied. We aim to describe subsequent recurrences in a large, contemporary, population-based cohort. Methods: We included 1,915 patients from the UroLife study and the Nijmegen Bladder Cancer Study, diagnosed with primary NMIBC between 2011 and 2021. The conditional 1-, 3- and 5-year risks of first to fourth recurrence were calculated using Kaplan-Meier risks, stratified by clinicopathological factors. Patterns of subsequent tumours were described and visualised. Key Findings and Limitations: We observed 671 first recurrences and 400 subsequent recurrences. The 3-year conditional recurrence risks for first, second and third recurrence were 31%, 45% and 54%, respectively, and were similar for NMIBC risk groups. Recurrence after a low-, intermediate- or high-risk tumour (either primary or recurrent) was again of low-, intermediate- or high-risk in 74%, 62% and 44% of cases, respectively. Ten patients with low/intermediate-risk NMIBC and 89 patients with high-risk NMIBC progressed to muscle-invasive or metastatic bladder cancer. Seven out of these ten (70%) and 13 out of these 89 (15%) patients had a high-risk recurrence before progression. This study was limited to a patient cohort from The Netherlands. Conclusions and Clinical Implications: Our study provides novel and reliable estimates of recurrence rates and patterns in NMIBC from a large, contemporary, population-based cohort. Recurring NMIBC tumours often exhibit similar clinicopathological characteristics, and patients with primary low- or intermediate-risk NMIBC who progress to MIBC/mBC often have a high-risk recurrence before progression. These results can inform research into NMIBC recurrences and surveillance schedules.

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Varying the intensity of cystoscopic surveillance for high‐risk non‐muscle‐invasive bladder cancer

Su,

Florissi,

Mahon

et al. 2024

BJU International

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ObjectivesTo compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).Patients and MethodsWe performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.ResultsThe guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.ConclusionIn microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients.

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Natural History of Multiple Recurrences in Intermediate-Risk Non-Muscle Invasive Bladder Cancer: Lessons From a Prospective Cohort

Cited by 3 publications

References 20 publications

International Bladder Cancer Group Intermediate-risk Nonmuscle-invasive Bladder Cancer Scoring System Predicts Outcomes of Patients on Active Surveillance

International Bladder Cancer Group Intermediate-risk Nonmuscle-invasive Bladder Cancer Scoring System Predicts Outcomes of Patients on Active Surveillance

Recurrence patterns in a large contemporary cohort of patients with non-muscle invasive bladder cancer

Varying the intensity of cystoscopic surveillance for high‐risk non‐muscle‐invasive bladder cancer

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