Contemporary outcomes and disease burden of high-grade T1 bladder cancer

High-grade T1 (HGT1) bladder cancer is considered to have high five-year recurrence and progression rates, at 50-70% and 25-50%, respectively; however, contemporary data are lacking. We examined the contemporary outcomes of HGT1 bladder cancer to inform patient counseling, management, and clinical trial design.

We identified patients aged ≥18 years with a new diagnosis of HGT1 bladder cancer between 2010 and 2022 treated at our institution. Recurrence-free (RFS), progression-free (PFS), and cancer-specific (CSS) survival were estimated using the Kaplan-Meier method. Associations of baseline characteristics with outcomes were evaluated using Cox regression.

A total of 213 patients were included, representing 332 cancer occurrences. Median age at diagnosis was 72 (interquartile range [IQR] 65-80) years. Median followup for RFS, PFS, and CSS was 13, 20, and 36 months, respectively. The one-, three-, and five-year event-free rates were 65%, 51%, and 48% for RFS; 85%, 78%, and 72% for PFS; and 99%, 95%, and 95% for CSS. There was a median of 1 (IQR 1-2) recurrence per patient, with a median time to first recurrence of seven months (IQR 4-14) and a median time between recurrences of seven months (IQR 5-18). Larger tumor size was associated with increased risks of recurrence. Receipt of adjuvant intravesical therapy was associated with reduced risks of recurrence and progression.

Contemporary five-year recurrence and progression rates for HGT1 bladder cancer remain high at 53% and 28%, respectively. The disease burden is substantial, with a median time between recurrences of seven months. These results can inform patient counseling, management, and clinical trial design.