Real-world management of T1 high-grade bladder cancer: A 14-year retrospective single-center study

T1 high-grade (T1HG) bladder cancer (BC) carries substantial risks of recurrence and progression, deserving of heightened clinical attention.

The present study evaluated the management approaches and reported 14-year real-world outcomes in patients with T1HG BC from a single-center cohort.

Data were retrospectively collected from primary T1HG patients who had undergone transurethral resection of bladder tumors (TURBT) at our institution between 2010 and 2023. A total of 165 patients were included. Their baseline characteristics, pathological findings, adjuvant therapies, recurrence, progression, and survival outcomes were analyzed. Predictors of tumor recurrence were modeled using multivariable analyses.

Tumor recurrence was significantly associated with post-operative Bacillus Calmette-Guérin (BCG) treatment (odds ratio [OR]: 0.315, p=0.001) and tumor multifocality (OR: 0.476, p=0.033). Among patients having received post-operative BCG treatment, tumor recurrence bore a significant correlation with tumor multifocality (OR: 0.328, p=0.027), and elevated body mass index (BMI) was identified as a potential accelerator of recurrence (hazard ratio: 1.098, p=0.01). The 10-year recurrence-free survival rate among all patients stood at 54.9% (95% confidence interval [CI]: 44.3-65.5%), with a median of 134 months (95% CI: 64.7-203.3 months). The rate of re-TURBT was 20%. The 10-year progression-free survival was 87.2% (95% CI: 81.0-93.5%) and the 10-year overall survival was 66.7% (95% CI: 54.0-79.4%). The 10-year cancer-specific survival and the 10-year cystectomy-free survival (CFS) rates were 93.7% (95% CI: 88.4-99.0%) and 86.3% (95% CI: 79.8-92.8%), respectively. Notably, BCG treatment significantly improved CFS (p=0.01).

Recurrence in T1HG disease is associated with BCG therapy and tumor multifocality, with a high BMI potentially promoting relapse.