MP24-09 SURVEILLANCE INTENSITY AND DETECTION OF RECURRENCE AND PROGRESSION IN INTERMEDIATE RISK NON MUSCLE INVASIVE BLADDER CANCER (NMIBC)

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP24)1 Apr 2020MP24-09 SURVEILLANCE INTENSITY AND DETECTION OF RECURRENCE AND PROGRESSION IN INTERMEDIATE RISK NON MUSCLE INVASIVE BLADDER CANCER (NMIBC) Abhishek Bhat*, Deukwoo Kwon, Nachiketh Soodana-Prakash, Indraneel Banerjee, Amit Bhattu, Venkatasai Atluri, Sanoj Punnen, Mark Gonzalgo, Dipen Parekh, and Chad Ritch Abhishek Bhat*Abhishek Bhat* More articles by this author , Deukwoo KwonDeukwoo Kwon More articles by this author , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash More articles by this author , Indraneel BanerjeeIndraneel Banerjee More articles by this author , Amit BhattuAmit Bhattu More articles by this author , Venkatasai AtluriVenkatasai Atluri More articles by this author , Sanoj PunnenSanoj Punnen More articles by this author , Mark GonzalgoMark Gonzalgo More articles by this author , Dipen ParekhDipen Parekh More articles by this author , and Chad RitchChad Ritch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000857.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intermediate risk (IR) NMIBC is a heterogeneous entity with a variable risk of recurrence and progression. The current American Urological Association (AUA)/Society of Urologic Oncology (SUO) guideline for NMIBC recommends cystoscopy and urine cytology every 3-6 months for the first two years and cross-sectional imaging every 1 to 2 years. However, this recommendation is based on expert opinion and there is limited data to support a specific surveillance interval. We compare several surveillance strategies of varying intensity with respect to the detection of recurrence and progression in IR-NMIBC. METHODS: A retrospective review was performed using The University of Miami NMIBC database for IR-NMIBC (2004-2018). We developed three surveillance models based on annual CT urogram and varying frequency of cystoscopy and urine cytology: Model 1 – every 3 months, Model 2 – every 6 months and Model 3 – every 12 months. Using the IR-NMIBC cohort, we applied each model and determined the proportion of patients whose recurrence or progression would have been missed over a two-year period by each model. We used descriptive statistics to determine the proportion of recurrences and progression detected in each model and Chi-square test to compare the rate of missed recurrences and progression between groups. We also compared the potential time-delay in diagnosis (in months) between models. RESULTS: 130 patients with IR NMIBC cancer were included in the database. 94 (72.3%) patients in the study cohort were males while 36 (27.7%) were females. 110 (84.6%) patients had Stage Ta at diagnosis and 16 (12.3%) were Stage T1. 94 (74.3%) patients were diagnosed with high grade disease whereas 36 (27.7%) patients had low grade disease. There were a total of 81 (62.3%) recurrences and 10 (7.7%) episodes of progression during the follow up period. Over a two-year simulation period, the mean proportion of missed recurrences in Model 2 and Model 3 as compared to Model 1 was 52.2% and 87% respectively. Progression was missed in Model 2 and Model 3 in 50% and 79% respectively as compared to Model 1 (Figure 1). With respect to time-delay in detection of recurrence, there was a 1.8 months delay for model 1, 3.7 months for model 2 and 8 months for model 3 (Figure 2). Of those who progressed, there were no deaths from bladder cancer and none required radical cystectomy. CONCLUSIONS: As recommended by the AUA/SUO guidelines, a 3-6 month window for surveillance in IR-NMIBC is appropriate and minimizes the proportion of missed recurrences and episodes of progression. Furthermore, there is less time-delay in the detection of recurrence using this surveillance intensity. Fortunately, although there are significantly more missed recurrences and progression with a less intense surveillance regimen, it is unlikely to result in the need for radical treatment or death from bladder cancer. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e350-e351 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Bhat* More articles by this author Deukwoo Kwon More articles by this author Nachiketh Soodana-Prakash More articles by this author Indraneel Banerjee More articles by this author Amit Bhattu More articles by this author Venkatasai Atluri More articles by this author Sanoj Punnen More articles by this author Mark Gonzalgo More articles by this author Dipen Parekh More articles by this author Chad Ritch More articles by this author Expand All Advertisement PDF downloadLoading ...