Yonsei Med J.  2016 Jul;57(4):855-864. 10.3349/ymj.2016.57.4.855.

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

• Kim HS
• Ku JH
• Kim SJ
• Hong SJ
• Hong SH
• Kim HS
• Kwon TG
• Cho JS
• Jeon SS
• Joo KJ
• Ahn HJ
• Park HS
• Seong DH
• Kwon DD
• Kim HJ
• Lim JS
• Lee HL

• KMID: 2374115
• DOI: http://doi.org/10.3349/ymj.2016.57.4.855

Abstract

PURPOSE
To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC).
MATERIALS AND METHODS
Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression.
RESULTS
With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy.
CONCLUSION
A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Keyword

Urinary bladder neoplasm; recurrence; disease progression; prognosis

MeSH Terms

Aged
Carcinoma in Situ/*mortality/*pathology/therapy
Disease Progression
Disease-Free Survival
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/*mortality/*pathology
Prognosis
Proportional Hazards Models
Republic of Korea
Retrospective Studies
Risk
Urinary Bladder Neoplasms/*mortality/*pathology/therapy

Figure

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  Fig. 1 Kaplan-Meier plots for recurrence-free survival (A) and progression-free survival (B) stratified by urine cytology result for the entire study cohort.

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  Fig. 2 Kaplan-Meier plots for recurrence-free survival (A) and progression-free survival (B) according to risk stratification.

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  Fig. 3 Kaplan-Meier plots for recurrence-free survival (A) and progression-free survival (B) stratified by induction intravesical BCG for patients with T1 high-grade urothelial carcinoma. BCG, Bacillus Calmette-Guérin.

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