Recurrence of high-risk bladder cancer: a population-based analysis

Area of Science:

• Urology
• Oncology
• Cancer Epidemiology

Background:

• Bladder cancer frequently recurs, necessitating ongoing patient intervention.
• High-grade, non-muscle-invasive bladder cancer (NMIBC) poses a significant risk of recurrence, progression, and mortality.

Purpose of the Study:

• To examine recurrence, progression, and bladder cancer-specific mortality rates in a cohort of patients with high-grade NMIBC.
• To identify risk factors associated with adverse outcomes in high-grade NMIBC.

Main Methods:

• Utilized linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1992-2007.
• Included patients diagnosed with high-grade NMIBC between 1992-2002, followed until 2007.
• Employed multivariate competing-risks regression analyses to assess outcomes.

Main Results:

• The 10-year rates for recurrence, progression, and bladder cancer mortality were 74.3%, 33.3%, and 12.3%, respectively.
• Stage T1 was linked to increased recurrence risk.
• Factors such as female sex, Black race, undifferentiated grade, and stages Tis/T1 increased progression and mortality risk. Advanced age (≥70) also elevated mortality risk.

Conclusions:

• Approximately 75% of high-grade bladder cancer patients experience recurrence, progression, or death within 10 years.
• While most do not die from bladder cancer, many suffer from recurrence and progression morbidity.
• Intravesical therapy and intensified surveillance, especially in the first two years, are recommended to minimize recurrences.