MP26-06 NEUTROPHIL TO LYMPHOCYTE RATIO PREDICTS RECURRENCE OF NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

INTRODUCTION AND OBJECTIVES: To report our experience of a prospective cohort study with a selected group of patients with low-risk non muscle-invasive bladder cancer (NMIBC) included in an observation and monitoring program after the diagnosis of recurrence. METHODS: Inclusion criteria: small (<10 mm) papillary, asymptomatic tumor with negative urinary cytology found on follow-up cystoscopy in patients with previous resections of NMIBC (Stage pTa, pT1a), grade 1-2, and number of lesions between 1 and 5. No symptomatic patients or those with carcinoma in situ or grade 3 tumors were included. All patients included in the observation group were closely monitored with cytology and flexible cystoscopy every 3-4 months. All pathologic studies were performed by a single experienced uropathologist and fully dedicated cytologists RESULTS: The data from 55 patients (70 active surveillance events) were analyzed. The mean patient age was 69.8 years. The median follow-up was 36 months. Pathologic characteristics before observation were pTa in 80%, Stage pT1a in 20%, grade 1 in 82% and grade 2 in 18%. The median time patients remained in observation was 18.9 months. Eighty-nine percent of the patients did not experience stage progression and 82% showed no grade progression. No patient experienced progression to muscle-invasive disease. The patients who discontinued the observational setting and underwent transurethral resection are those who showed an increase in the number and/or size of the lesions, a worsening of the symptoms (mainly haematuria), or positive urine cytology findings at follow up. CONCLUSIONS: The observation of these tumors, without active treatment, is a common clinical practice; however, although routinely performed by some urologists, clinical guidelines do not take this option into account yet. An active surveillance protocol is reasonable in patients presenting with small, recurrent papillary bladder cancer after resection of low grade Ta T1 tumors. The observational option allows to spare several surgeries, also considering the minimal risk for tumor progression in these patients. Whenever a significant change in tumor morphology or size is noted, patients are referred to a standard transurethral resection of bladder tumor (TURBT).