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Long-term outcome of transurethral laser ablation for recurrent non-muscle invasive bladder cancer: An EORTC
Chase Peng Yun Ng1, Alexander Light1,2, Charis Eleftheriou1
1Imperial Urology Imperial College Healthcare NHS Trust London UK.
Introduction:
Elderly and comorbid patients with non-muscle invasive bladder cancer (NMIBC) often undergo repeated transurethral resection of bladder tumour (TURBT) under general anaesthesia. Transurethral laser ablation (TULA) is an outpatient-based alternative with lower morbidity, cost and carbon footprint, but its long-term efficacy is not well-established. We report the long-term outcomes of recurrent NMIBC treated with TULA, stratified by European Organisation for Research and Treatment of Cancer (EORTC) risk groups.
Materials And Methods:
We conducted a single-centre, retrospective cohort study, including all consecutive NMIBC patients treated with TULA between 2012 and 2023. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS) and secondary outcomes included cancer-specific survival (CSS), overall survival (OS) and complications, stratified by EORTC risk groups. Data were analysed using Kaplan-Meier survival analysis and Cox regression model.
Results:
Three hundred and nineteen patients (1186 TULAs), with a median age of 77 and median Charleson Comorbidity Index of 7, were included. Median follow up was 4.4 years. The 5-year RFS of intermediate-risk and high-risk NMIBC treated with TULA were 31.8% (95%CI:25.6-39.7%) and 29.0% (95%CI: 20.1-42.0%), respectively, with no significant difference (p:0.47). The 5-year PFS were 86.8% (95%CI: 82.1-91.7%) and 93.1% (95%CI: 85.2-100.0%), respectively. Overall, the 10-year OS and CSS were 50.7% (95% CI: 41.8-61.5%) and 96.1% (95%CI: 93.3-98.9%), respectively. The complication rate was 4.0%. Age was the only positive predictor of recurrence. Limitations include missing data (7.9%) and single-centre retrospective design.
Conclusion:
TULA is a safe, minimally invasive treatment with long-term efficacy for elderly and comorbid patients with recurrent NMIBC. Although recurrence rate at 5 years were high, progression rate, especially muscle invasion, was low and reassuring. Long-term overall survival and cancer-specific survival remained excellent.
