Outcomes of Intermediate Risk Non-muscle-invasive Bladder Cancer Receiving Adjuvant Treatment: A Pooled Analysis of...

Area of Science:

• Urology
• Oncology
• Clinical Trials

Background:

• Historic prediction models may overestimate recurrence and progression risks for intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC).
• Evaluating outcomes in IR-NMIBC patients is crucial for optimizing surveillance protocols.

Purpose of the Study:

• To assess oncological outcomes for patients with IR-NMIBC.
• To determine the appropriateness of current surveillance cystoscopy protocols based on real-world data.

Main Methods:

• Pooled individual patient data from four randomized controlled trials (HIVEC-II, PHOTO, BOXIT, CALIBER) were analyzed.
• Kaplan-Meier analyses were used to evaluate oncological endpoints, including recurrence-free rates.
• Noncumulative recurrence distribution was assessed to inform surveillance strategies.

Main Results:

• Analysis included 578 IR-NMIBC patients with a median follow-up of 34 months.
• Recurrence rates showed no significant increase between 36 and 60 months (56% vs. 54% recurrence-free).
• Higher recurrence risk was associated with prior recurrences, multifocality, and cancer grade; grade/stage progression was uncommon (<5%).

Conclusions:

• IR-NMIBC patients experience a high risk of recurrence within the first 36 months.
• Grade and stage progression are infrequent, with a 99% cancer-specific survival at 60 months.
• Reducing or terminating cystoscopy surveillance after 60 months may be appropriate due to a low risk of later recurrence.