Natural History of Multiple Recurrences in Intermediate-Risk Non-Muscle Invasive Bladder Cancer: Lessons From a...

Area of Science:

• Urology
• Oncology

Background:

• Prognostic studies for intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) primarily focus on initial recurrence.
• Little is known about the frequency and impact of multiple recurrences on disease progression in IR-NMIBC patients.

Purpose of the Study:

• To describe the risk of multiple recurrences in IR-NMIBC.
• To evaluate the impact of multiple recurrences on disease progression.

Main Methods:

• A prospective cohort study (Be-Well Study) identified 291 IR-NMIBC patients diagnosed between 2015-2019.
• Conditional Kaplan-Meier analyses and random-effects shared-frailty models were used to characterize recurrence frequency.
• Multivariable analysis examined associations with multiple recurrences and progression.

Main Results:

• The 5-year risk of initial recurrence was 54.4%.
• Following initial recurrence, 60.1% experienced a second recurrence by 2 years, and 51.5% had a third by 3 years.
• Female sex, increasing tumor size, and prior recurrences were associated with multiple recurrences, while maintenance BCG was associated with fewer recurrences. The 5-year risk of progression increased from 9.5% (1 recurrence) to 37.9% (3+ recurrences).

Conclusions:

• Multiple recurrences are frequent in IR-NMIBC and are linked to disease progression.
• Female sex, larger tumors, prior recurrences, and lack of maintenance BCG are associated with increased recurrence risk.
• Multiple recurrences may serve as a valuable clinical trial endpoint for IR-NMIBC.