Clinical and Pathological Prognostic Factors for Recurrence, Progression and Mortality in Non-Muscle Invasive Bladder Cancer: A Meta-Analysis

Abstract

Introduction: We aimed to quantify the importance of conventional clinical and pathological prognostic factors in the outcome of non-muscle invasive bladder cancer based on literature. Materials: We identified 14 publications that reported on the association between clinical and pathological prognostic factors for tumor recurrence, tumor progression and overall mortality of non-muscle invasive bladder cancer. Relative risks (RR) were estimated using meta-analytic techniques to combine results of separate studies. Results: In total, 2,536 of 5,021 patients had a tumor recurrence, 317 of 3,313 had tumor progression and 531 of 1,548 died. The strongest prognostic factor for tumor recurrence was the result of the first 3-monthly cystoscopy (RR 2.2, 95% confidence interval (CI) 1.8–2.7). The strongest prognostic factor for tumor progression was grade 3 compared to grade 1 (RR 6.7, 95% CI 4.7–9.5). The presence of carcinoma in situ had a strong effect on tumor progression (RR 4.4, 95% CI 3.4–5.5) and on the overall mortality (RR 4.0, 95% CI 2.4–6.5). Tumor shape, grade 3 and patient age also had strong effects on survival. Conclusion: Clinical and pathological prognostic factors could not predict tumor recurrence, but showed strong associations with tumor progression and overall mortality. To individualize surveillance strategies emphasis should be on the search for a panel of conventional and molecular prognostic factors that can reliably predict recurrence and progression.