Late recurrence and progression in non-muscle-invasive bladder cancers after 5-year tumor-free periods

Urology. 2010 Jun;75(6):1385-90. doi: 10.1016/j.urology.2009.09.088. Epub 2010 Jan 29.

Abstract

Objectives: To evaluate the recurrence and progression in patients with non-muscle-invasive bladder tumors who remained tumor-free for at least 5 years, which should assist in the development of schedules of their follow-up evaluations. Non-muscle-invasive bladder tumors that recur or progress at a late time point are not rare.

Methods: Between 1985 and 2002, 814 cases diagnosed with non-muscle-invasive bladder cancer were treated with transurethral resection. Of these 814 cases, 262 patients with no tumor recurrence for more than 5 years were included in the study. The median follow-up interval was 10.0 years.

Results: During the follow-up period, 39 tumors (14.9%) showed tumor recurrence. The 5- and 10-year recurrence-free survival rates were 81.6% and 76.0%, respectively. There was no significant difference in tumor recurrence among the low-, intermediate-, and high-risk groups based on the current clinical guideline. Only the use of intravesical mitomycin C was determined to be a significant unfavorable risk factor for late recurrence. Five patients (1.9%) experienced stage progression, 3 of whom did not have metastases at the time of diagnosis of the progression but died because of bladder cancer disease.

Conclusions: After a 5-year tumor-free period, even in the low-risk group, recurrence occurred at a late time point to a degree that was the same as that for the intermediate- and high-risk groups. Finally, some of the high-risk patients experienced late progression with a high degree of malignant behavior, suggesting longer follow-up is needed for each patient.

MeSH terms

  • Administration, Intravesical
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Biopsy, Needle
  • Carcinoma, Transitional Cell / mortality*
  • Carcinoma, Transitional Cell / pathology*
  • Carcinoma, Transitional Cell / therapy
  • Chemotherapy, Adjuvant
  • Cohort Studies
  • Cystectomy / methods
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Multivariate Analysis
  • Neoplasm Invasiveness / pathology*
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Probability
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Time Factors
  • Urethra / surgery
  • Urinary Bladder Neoplasms / mortality*
  • Urinary Bladder Neoplasms / pathology*
  • Urinary Bladder Neoplasms / therapy
  • Young Adult