Cancer Res Treat.  2015 Jul;47(3):495-500. 10.4143/crt.2014.050.

Previous Bladder Cancer History in Patients with High-Risk, Non-muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History

• Mitrakas L
• Zachos IV
• Tzortzis V
• Gravas SA
• Rouka EC
• Dimitropoulos KI
• Vandoros G
• Karatzas A
• Melekos MD
• Papavassiliou AG

• KMID: 2148500
• DOI: http://doi.org/10.4143/crt.2014.050

Abstract

PURPOSE
The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guerin (BCG) and to evaluate their natural history.
MATERIALS AND METHODS
Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups.
RESULTS
A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival.
CONCLUSION
Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.

Keyword

High-risk; Non-muscle-invasive bladder cancer; Previous bladder cancer history; Recurrence; Disease progression

MeSH Terms

Bacillus
Carcinoma in Situ
Disease Progression
Disease-Free Survival
Humans
Logistic Models
Mycobacterium bovis
Natural History*
Recurrence*
Urinary Bladder Neoplasms*

Figure

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  Fig. 1. Kaplan-Meier survival curves for the difference in recurrence free survival between patients with primary (blue) and non-primary (green) tumors.

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  Fig. 2. Kaplan-Meier survival curves for the difference in progression free survival between patients with primary (blue) and non-primary (green) tumors.

Reference

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