Abstract
BackgroundWe evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system.MethodsWe retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years.ResultsTumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence.ConclusionsMultiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis.
Highlights
We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system
When we divided the patients into two groups, those with or without tumor recurrence, there were no significant differences in age, gender, intravesical instillation (IVI) or smoking status between the two groups (Table 1)
Univariate and multivariate analyses demonstrated that multiple tumor and absence of IVI were significant risk factors for tumor recurrence (Table 2)
Summary
We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. To the best of our knowledge, there have been no reports with longer follow-up data focusing on the effects of IVI on tumor recurrence and progression in patients with low grade Ta tumors based on the 2004 WHO classification [4,5]. There are few published studies in which a large number of patients were followed for more than 5 years after the initial diagnosis. Some long follow-up studies showed most tumors recurred or progressed within 5 years, recent data support the need for long term follow-up for more than 10–15 years in such patients even after an initial response to BCG therapy and a recurrence-free period for more than 5 years [6]
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