Abstract
ABSTRACTPurpose:Non - muscle - invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor - promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence.Materials and Methods:We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 – 2016. Means were compared with independent T - test and proportions with chi - square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence.Results:The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty - one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy - proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 – 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 – 1.47, p = 0.005).Conclusions:The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.
Highlights
75% of bladder cancer patients present with non - muscle invasive disease classified as Ta, T1, or carcinoma in situ (CIS) [1, 2].Non - muscle invasive bladder cancer (NMIBC) has a high rate of recurrence and progression despite local treatment [3]
International Prostate Symptom Score (IPSS) consisted of seven questions regarding urinary bother, which were subcategorized into questions dealing with voiding symptoms and those dealing with storage symptoms, as well as an overall quality of life (QoL) score
American Society of Anesthesiologists (ASA) score was assessed at time of TURBT, and followup was defined from time of initial TURBT until date of last contact or death
Summary
75% of bladder cancer patients present with non - muscle invasive disease classified as Ta (mucosa only), T1 (lamina propria invasion), or carcinoma in situ (CIS) [1, 2]. Non - muscle invasive bladder cancer (NMIBC) has a high rate of recurrence and progression despite local treatment [3]. Recurrence rates range from < 20% for low - grade, Ta lesions to 80% for high grade, T1 tumors [4]. Probabilities for recurrence are dependent on tumor size, grade, stage, ibju | LUTS increases recurrence of bladder cancer multiplicity, and initial response to intravesical therapy [5]. Risk factors for urothelial carcinoma (UC) include tobacco abuse, which is estimated to account for 50% of tumors [6]. It is hypothesized that tobacco products exert a tumor - promoting effect on the urothelial cells of the bladder mucosa through direct contact with the urine via mechanisms such as immunomodulation [7]
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