The impact of frequent cystoscopy on surgical care and cancer outcomes among patients with low‐risk, non–muscle‐invasive bladder cancer

Abstract

BACKGROUND:Surveillance recommendations for patients with low-risk, non-muscle-invasive bladder cancer (NMIBC) are based on limited evidence. The objective of this study was to add to the evidence by assessing outcomes after frequent versus recommended cystoscopic surveillance. METHODS: This was a retrospective cohort study of patients diagnosed with low-risk (low-grade Ta (AJCC)) NMIBC from 2005 to 2011 with follow-up through 2014 from the Department of Veterans Affairs. Patients were classified as having undergone frequent versus recommended cystoscopic surveillance (>3 vs 1-3 cystoscopies in the first 2 years after diagnosis). By using propensity score-adjusted models, the authors estimated the impact of frequent cystoscopy on the number of transurethral resections, the number of resections without cancer in the specimen, and the risk of progression to muscle-invasive cancer or bladder cancer death. RESULTS: Among 1042 patients, 798 (77%) had more frequent cystoscopy than recommended. In adjusted analyses, the frequent cystoscopy group had twice as many transurethral resections (55 vs 26 per 100 person-years; P < .001) and more than 3 times as many resections without cancer in the specimen (5.7 vs 1.6 per 100 person-years; P < .001). Frequent cystoscopy was not associated with time to progression or bladder cancer death (3% at 5 years in both groups; P = .990). CONCLUSIONS: Frequent cystoscopy among patients with low-risk NMIBC was associated with twice as many transurethral resections and did not decrease the risk for bladder cancer progression or death, supporting current guidelines. Cancer 2019;125:3147-3154.

The impact of low- versus high-intensity surveillance cystoscopy on surgical care and cancer outcomes in patients with high-risk non-muscle-invasive bladder cancer (NMIBC)

“…First, we enumerated transurethral resections (including cystoscopy with biopsy) during a 2-to 9-year follow-up period using CPT and International Classification of Diseases (ICD), Ninth Revision, procedure codes as previously defined. [13] The follow-up period for our outcomes analysis started with the date of diagnosis and ended with the date of cystectomy, radiotherapy, cancer recurrence, death, last contact with the VA system, or at the end of the study (December 31, 2014), whichever came first. Resections performed less than 30 days apart were not considered in the enumeration of transurethral resections.…”

“…[14] Bladder cancer death was defined using ICD, tenth revision, codes from the NDI. [13] Lastly, NLP algorithms were used to identify patients with Ta disease who progressed to invasive disease. Of note, progression to invasive disease included progression to any invasive disease, including invasion into the lamina propria (T1) or into the muscularis propria (T2).…”

The Diagnostic Value of LncRNAs for Bladder Cancer: A Meta-Analysis

“…It may even lead to anxiety and depression before or after the cystoscopy in patients [12] , which increases the pain of patients, reduces the compliance of patients' monitoring, and reduces the survival rate of patients in disguised form [13] . And even increasing the frequency of cystoscopy can't delay the disease progression and death of patients [14] . At present, there are also some non-invasive methods for the diagnosis of bladder cancer, such as urine exfoliation cytology, but it also has obvious shortcomings, its sensitivity is low [15] , especially in the early stage of tumor, cell adhesion is good, it is not easy to fall off, resulting in its sensitivity is greatly reduced, in addition, in ammation, radiotherapy, chemotherapy and other may lead to false negative.…”

An evaluation of the real world use and clinical utility of the Cxbladder Monitor assay in the follow-up of patients previously treated for bladder cancer

“…There is evidence to suggest that the benefit: risk equation for diagnostic and surveillance procedures does not necessarily favor current practices [12][13][14]. For example, American Urological Association (AUA) guidelines for the evaluation of hematuria recommend extensive and intensive use of tests and procedures, including CT imaging [10], impacting significantly on costs, compared with guidelines that recommend less intensive assessment [12].…”

“…Comparatively less intensive approaches miss more lowgrade UCs, but with fewer adverse outcomes [12]. Moreover, studies specifically investigating the surveillance of patients after treatment for UC suggest that low-risk patients often undergo more frequent surveillance cystoscopies than is recommended by AUA guidelines [13,14]. Such overuse is associated with increases in surgical procedures and total medical costs, without reducing risk of UC progression or death [14].…”