Diagnostic delay and prognosis in invasive bladder cancer

To study diagnostic delay in invasive bladder cancer in a population-based material with long-term follow-up, and to evaluate whether delay in diagnosis affects the risk of bladder cancer death.

In a previous study, 177 patients with invasive bladder cancer (T1-T4) diagnosed in 1988 were investigated with regard to diagnostic delay. A review of all available clinical records was performed. In the present study, causes of death for these patients were registered over a 12-year follow-up period, and the impact of diagnostic delay on bladder cancer death was studied by means of survival analysis.

The median diagnostic delay in the material was 144 days. When the patients were stratified into groups with diagnostic delays of 0-3, 3-6, 6-12 and >12 months, those with T1 tumours in the two groups with a diagnostic delay of <6 months showed a trend towards a decreased risk of bladder cancer death. In contrast, in patients with muscle-invasive disease, a significantly increased risk of bladder cancer death was noted for those with a diagnostic delay of <6 months.

A trend towards better prognosis was found for patients with T1 tumours with a shorter diagnostic delay. The poor prognosis of patients with muscle-invasive disease and a short diagnostic delay suggests aggressive behaviour of the tumour and may explain the worse prognosis in these patients.