The Impact of Non-compliance to Standardized Risk-adjusted Protocol in Non-Muscle Invasive Bladder Cancer on Recurrence, Progression and Mortality: Lessons to Learn in the Era of COVID-19

Abstract

BackgroundNon-Muscle Invasive Bladder Cancer (NMIBC) is potentially curable or a controllable disease if strict adherence to surveillance protocol is followed. Management and surveillance of NMIBC begin at the time of diagnosis up to few years thereafter based on the risk group category. There is scanty data in the literature evaluating the impact of non-compliance to surveillance protocol on progression, recurrence, and mortality rate. We do believe that this data will add to the literature especially during the COVID-19 pandemic which affects and delays daily elective surgeries. MethodsA retrospective study of two hundred bladder biopsy and resection between 2012-2017. Eighty-eight patients with minimal 3 years follow up data were included. Patients were divided into 2 groups based on their compliance with the cystoscopy follow up as recommended by the European guidelines. We compared the cystoscopy compliant group to the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance are calculated in a new scoring model to predict the adverse outcome. ResultsRecurrence rate (RR), progression rate (PR), metastasis rate (MsR) and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (P<0.001), PR: (54.1%) (P<0.001), MsR: (37.7%) (P<0.001), MR: (23.5%) (P= 0.002) respectively. In subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group while it is 100% (P<0.001) and 56.4% (P=0.001) in the non-compliant group respectively. Kaplan Meier (KM) graph shows that compliant patients were more likely to be better than non-compliant. ConclusionsNoncompliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group which mandates strict adherence to surveillance guidelines to improve outcomes in NMIBC.