Previous Bladder Cancer History in Patients with High-Risk, Non–muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History

Abstract

PurposeThe purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non–muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette–Guérin (BCG) and to evaluate their natural history.Materials and MethodsPatients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups.ResultsA total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival.ConclusionPrevious non–muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.

Extensive rhabdomyosarcomatous differentiation in recurrent low-grade urothelial carcinoma of the bladder after transurethral resection: a case report

“…However, our patient had not received any anti-cancer treatment except for TUR of low-grade UC. It has been reported that past history of non-invasive cancer correlates with the malignant grade in secondary UC [ 11 ]. In addition, the role of inflammation in urothelial cell carcinogenesis has lately been receiving considerable attention [ 12 ].…”

Quality of life and anxiety in patients with non-muscle invasive bladder cancer: a prospective study

“…All patients underwent endoscopic resection of the bladder tumour under spinal anesthesia. Three weeks postoperatively they initiated adjuvant intravesical therapy of either BCG or epirubicin instillations on an outpatient basis, as described elsewhere (14).…”

Treatment Outcomes of High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) in Real-World Evidence (RWE) Studies: Systematic Literature Review (SLR)

“…16,17,21,22,[24][25][26][27][28]31,[33][34][35][36][37]40,42,49,51,54,56,57,61,65,68,74,75,77 Among the remaining eight studies, rates of BCG induction therapy ranged from 29% to 95%. 20,45,47,52,59,63,77,78 The use of maintenance BCG in HR-NMIBC was reported in 31 studies, with rates being more variable than those seen with induction therapy. 16,17,[26][27][28][29]31,33,34,36,37,40,42,45,46,[49]…”

“…37,42,58 The use of re-TURBT in patients with HR-NMIBC was reported in 43 studies. 16,[18][19][20][21][22][23][27][28][29][30][31][32][33]37,[41][42][43]45,47,[49][50][51][52][53][54][55][56]58,64,69,70,74,77,78,[83][84][85][86][87][88][89][90] Across 27 studies, the use of this procedure varied from 15% to 82%, 16,18,[20][21][22][30]…”