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Mechanisms of recurrence of Ta/T1 bladder cancer
Richard T Bryan1, Stuart I Collins, Mark C Daykin
1Department of Public Health, Epidemiology and Biostatistics, School of Population Sciences, University of Birmingham, Birmingham, UK. r.t.bryan@bham.ac.uk
Introduction:
Bladder cancer recurrence occurs via four mechanisms - incomplete resection, tumour cell re-implantation, growth of microscopic tumours, and new tumour formation. The first two mechanisms are influenced by clinicians before and immediately after resection; the remaining mechanisms have the potential to be influenced by chemopreventive agents. However, the relative importance and timing of these mechanisms is currently unknown. Our objective was to postulate the incidence and timing of these mechanisms by investigating the location of bladder cancer recurrences over time.
Patients And Methods:
The topographical locations of tumours and their recurrences were analysed retrospectively for 169 patients newly-diagnosed with Ta/T1 bladder cancer, with median follow-up of 33.8 months. Tumours were assigned to one or more of six bladder sectors, and time to recurrence and location of recurrences were recorded.
Results:
Median time to first tumour recurrence was 40 months. Median times between subsequent recurrences were 6.6, 7.9, 8.0 and 6.6 months for recurrences 1 to 2, 2 to 3, 3 to 4, and 4 to 5, respectively. The risk of first tumour recurrence in any given bladder sector increased by nearly 4-fold if the primary tumour was resected from that sector (P < 0.001); this association was not significant for subsequent recurrences. The proportion of tumour recurrences in multiple bladder sectors increased from 13% for the first recurrence to 100% for recurrence seven onwards.
Conclusions:
First tumour recurrence appears different to subsequent recurrences; incomplete resection and tumour cell reimplantation may dominate at this time-point. Only later does genuine new tumour formation appear to increase in importance. This has important implications for clinical trials, especially those involving chemopreventive agents.
Insights
Bladder cancer recurrence mechanisms differ. Initial recurrences stem from incomplete resection or cell reimplantation, while later ones suggest new tumor growth, impacting chemoprevention strategies.
Area of Science:
- Urology
- Oncology
- Cancer Research
Background:
- Bladder cancer recurrence involves incomplete resection, tumor cell reimplantation, microscopic tumor growth, or new tumor formation.
- The timing and importance of these recurrence mechanisms are not well understood.
- Chemopreventive agents may influence later recurrence mechanisms.
Purpose of the Study:
- To investigate the incidence and timing of bladder cancer recurrence mechanisms.
- To analyze the topographical locations of tumors and their recurrences over time.
Main Methods:
- Retrospective analysis of 169 patients with newly-diagnosed Ta/T1 bladder cancer.
- Tumors and recurrences mapped to six bladder sectors.
- Median follow-up of 33.8 months.
Main Results:
- Median time to first recurrence was 40 months; subsequent recurrences occurred every 6.6-8.0 months.
- First recurrence risk increased nearly 4-fold if the primary tumor was in the same sector (P < 0.001).
- Recurrence in multiple sectors increased from 13% (first recurrence) to 100% (seventh recurrence onwards).
Conclusions:
- First bladder cancer recurrence is likely due to incomplete resection and tumor cell reimplantation.
- New tumor formation becomes more significant for subsequent recurrences.
- Findings have implications for clinical trials and chemoprevention strategies.
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