Risk Factors Predictive of Recurrence and Progression for Patients Who Suffered Initial Recurrence After Transurethral Resection of Stage pT1 Bladder Tumor in Chinese Population

Abstract

Bladder cancer is one of the most common malignancies worldwide and the stage pT1nonmuscle invasive bladder cancer (NMIBC) has a high probability of recurrence after initial diagnosis and treatment. However, risk factors predictive of repeated recurrence and progression of pT1 bladder tumors after primary relapse have not been uncovered. Thus, we conducted the retrospective study.A total of 418 patients who suffered initial recurrence after transurethral resection (TUR) of pT1 bladder tumor were selected for the analyses. Clinic information of the patients was retrieved from their medical records. Recurrence-free survival (RFS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Univariate and multivariate analyses were performed using a Cox proportional hazards regression model. The probability of recurrence and progression by multivariate analyses was used as a surrogate marker to construct receiver operating curve (ROC).Results showed that variables including time to prior recurrence time, prior treatment, number of tumor, tumor size, tumor grade, and time of instillation after surgery were associated with the repeated recurrence of pT1 bladder tumor (P < 0.05). The variables including time to prior recurrence time, tumor size, tumor grade, carcinoma in situ (CIS), and time of instillation after surgery were associated with progression of pT1 bladder tumor (P < 0.05). In the present study, the multivariate model showed an area under ROC (AUC) value of 0.754 and 0.798 for tumor recurrence and progression, respectively, which was more effective in prediction than a single risk factor.In conclusion, we have identified several risk factors relevant to RFS and PFS for patients who have had a history of recurrence of pT1 bladder tumor after TUR. These predictive factors may help urologists to stratify patients into distinct risk groups of recurrence and progression, which probably contributes to the individualized treatment for patients.

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

“…Initial tumor size, tumor multifocality, tumor grade, history of recurrence, a shorter timing of intravesical therapy, and presence of CIS are all disease specific variables associated with recurrence [14][15][16]. Similarly, in our cohort, tumor size, tumor multifocality, and the presence of concomitant CIS were associated with higher odds of recurrence and time to recurrence for NMIBC recurrence.…”

Validation of EORTC, CUETO and EAU risk stratification in prediction of recurrence, progression and death of patients with initially non-muscle invasive bladder cancer (NMIBC): a cohort analysis with systematic review.

“…This approach was adopted in several similar studies, e.g. by Shen et al [15] Our systematic analysis has also shown the inconsistency in reporting the validity of utilized stratification approaches. For example, very recent analysis of 301 patients by Wang et al [16] or the analysis of 1436 patients by Rieken et al [17] (e.g.…”

Validation of EORTC, CUETO, and EAU risk stratification in prediction of recurrence, progression, and death of patients with initially non–muscle‐invasive bladder cancer (NMIBC): A cohort analysis

“…The individual surgeon has a significant impact on the risk of recurrence after curative treatment of patients with NMIBC, as described previously, 13 and another approach could aggravate the lead-time bias. A similar reasoning has been adopted in several similar studies 14 Our systematic analysis also demonstrates the inconsistency in reporting the validity of utilized stratification approaches. For example, neither the very recent analysis of 301 patients by Wang et al 15 nor an analysis of 1436 patients, a group without immediate postoperative instillation of chemotherapy, by Rieken et al 16 could be included in the review due to lack of c-index or AUCROC analysis.…”

“…The individual surgeon has a significant impact on the risk of recurrence after curative treatment of patients with NMIBC, as described previously, 13 and another approach could aggravate the lead‐time bias. A similar reasoning has been adopted in several similar studies 14 …”