PD63-06 THE NATURAL HISTORY OF MULTIPLE RECURRENCES IN INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: LESSONS FROM A PROSPECTIVE COHORT

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-06 THE NATURAL HISTORY OF MULTIPLE RECURRENCES IN INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: LESSONS FROM A PROSPECTIVE COHORT Vidit Sharma, Katherine E Fero, Patrick M Lec, Karim Chamie, Valerie S Lee, Charles Quesenberry, Julie R Munneke, Mark Schoenberg, David S Aaronson, Lawrence H Kushi, Li Tang, and Marilyn L Kwan Vidit SharmaVidit Sharma More articles by this author , Katherine E FeroKatherine E Fero More articles by this author , Patrick M LecPatrick M Lec More articles by this author , Karim ChamieKarim Chamie More articles by this author , Valerie S LeeValerie S Lee More articles by this author , Charles QuesenberryCharles Quesenberry More articles by this author , Julie R MunnekeJulie R Munneke More articles by this author , Mark SchoenbergMark Schoenberg More articles by this author , David S AaronsonDavid S Aaronson More articles by this author , Lawrence H KushiLawrence H Kushi More articles by this author , Li TangLi Tang More articles by this author , and Marilyn L KwanMarilyn L Kwan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002107.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, prognostic studies of intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) have focused on the risk of initial recurrence, yet little is known about subsequent recurrences and their impact on progression. In a prospective cohort study, we describe the full spectrum of multiple recurrences and their impact on progression for IR-NMIBC. METHODS: IR-NMIBC patients from the Be-Well Study, a prospective cohort study of NMIBC patients diagnosed from 2015-2019 at Kaiser Permanente Northern California, were identified. The primary objective was to characterize the frequency of first, second, and third intravesical recurrences of urothelial carcinoma using conditional Kaplan-Meier analyses and random effects shared frailty models. The association of multiple recurrences with progression (any grade or stage) was also examined. RESULTS: Out of 808 eligible patients, 291 patients with intermediate-risk NMIBC were identified (median follow up 38 months). Patients had a 54.4% 5-year risk of recurrence. After initial recurrence (n=137), 60.1% of patients had a second recurrence by 2 years. After second recurrence (n=70), 51.5% of patients had a third recurrence by 3 years. These risks did not vary significantly by initial tumor grade (Figure 1A). The majority of second and third recurrences occurred within 2 years of the prior recurrence. On multivariable analysis, female sex (Hazard Ratio 1.60, p<0.01) and increasing tumor size (HR 1.18, p<0.01) were associated with multiple recurrences. The 5-year risk of progression was 9.4%, and this varied significantly (p<0.001) by number of recurrences: 9.5%, 21.9%, 37.9% for patients with 1, 2, and 3 or more recurrences, respectively (Figure 1B). CONCLUSIONS: Patients with IR-NMIBC frequently have multiple recurrences, with female patients and larger tumors more likely to have multiple recurrences. In turn, patients with multiple recurrences are more likely to experience grade or stage progression. Examining the burden of multiple recurrences may prove useful as a clinical trial endpoint for this understudied subgroup of bladder cancer patients. Source of Funding: Vidit Sharma is supported by the VA HSRD fellowship © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1140-e1140 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma More articles by this author Katherine E Fero More articles by this author Patrick M Lec More articles by this author Karim Chamie More articles by this author Valerie S Lee More articles by this author Charles Quesenberry More articles by this author Julie R Munneke More articles by this author Mark Schoenberg More articles by this author David S Aaronson More articles by this author Lawrence H Kushi More articles by this author Li Tang More articles by this author Marilyn L Kwan More articles by this author Expand All Advertisement Loading ...