1357 LATE RECURRENCE AND PROGRESSION IN NON-MUSCLE INVASIVE BLADDER CANCERS AFTER 5-YEAR TUMOR-FREE PERIODS: CAN EXISTING RISK STRATIFICATION PROVIDE ACCURATE ESTIMATES OF LATE RECURRENCE AND PROGRESSION?

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20101357 LATE RECURRENCE AND PROGRESSION IN NON-MUSCLE INVASIVE BLADDER CANCERS AFTER 5-YEAR TUMOR-FREE PERIODS: CAN EXISTING RISK STRATIFICATION PROVIDE ACCURATE ESTIMATES OF LATE RECURRENCE AND PROGRESSION? Kazuhiro Matsumoto, Eiji Kikuchi, Hiroyuki Yamanaka, Masayuki Hagiwara, Akiharu Ninomiya, Akira Miyajima, Ken Nakagawa, So Nakamura, and Mototsugu Oya Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Hiroyuki YamanakaHiroyuki Yamanaka More articles by this author , Masayuki HagiwaraMasayuki Hagiwara More articles by this author , Akiharu NinomiyaAkiharu Ninomiya More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , Ken NakagawaKen Nakagawa More articles by this author , So NakamuraSo Nakamura More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.984AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Non-muscle invasive bladder tumors (NMIBT) that recur or progress at a late time point are not rare. However, it is uncertain how and how long we should follow patients with NMIBT who have not experienced tumor recurrence beyond a 5-year tumor-free period. The aim of the present study was to evaluate the recurrence and progression in patients who remained tumor-free for at least 5 years, which should assist in the development of schedules for their follow-up evaluations. METHODS Between 1985 and 2004, 1314 cases with diagnosed NMIBT were treated with TUR-BT at our two institutions (median follow-up, 10 years). Of these 1314 cases, 361 patients without any tumor recurrence for more than 5 years were included in the study. The starting point of the study was 5 years after TUR-BT. RESULTS The overall 5-year and 10-year recurrence-free survival rates were 82.8% and 76.3%, respectively. All patients were divided into three risk groups referring to the current AUA guideline. There was no significant difference in tumor recurrence among the three risk groups after the 5-year tumor-free period. None of the 43 low risk patients with a 10-year tumor-free period after TUR-BT experienced any subsequent tumor recurrence, however, tumor recurrence was observed in 4 of 30 intermediate risk patients and in 2 of 37 high risk patients after the 10-year tumor-free period. Multivariate analysis revealed that only the use of intravesical mitomycin C was a significant unfavorable risk factor for late recurrence (p<0.001). The 5-year and 10-year progression-free survival rates were 97.8% and 97.8%, respectively. Four of 7 progression patients died due to bladder cancer and all 4 belonged to the high risk group. CONCLUSIONS Our long-term follow-up outcome indicated that the risk stratification provided by the current guideline could not accurately predict the late recurrences, and emphasized that long-term follow-up data could identify the true prognostic factors for tumor recurrence and/or progression in patients with NMIBT. Based on our retrospective long-term follow-up data, it can be concluded that since solitary Ta G1-2 cancer (low risk tumor) did not recur beyond 10 years, follow-up could be discontinued after a 10-year dormancy period in low-risk patients. Patients with Ta G3, T1 G2-3, and/or concomitant CIS cancer (high risk tumor) may experience progression even after a 5-year tumor-free period and should perhaps continue to be followed-up carefully. Tokyo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e524 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuhiro Matsumoto More articles by this author Eiji Kikuchi More articles by this author Hiroyuki Yamanaka More articles by this author Masayuki Hagiwara More articles by this author Akiharu Ninomiya More articles by this author Akira Miyajima More articles by this author Ken Nakagawa More articles by this author So Nakamura More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...