The Natural History of Non-Muscle-Invasive Transitional Cell Carcinoma of the Bladder

Abstract

Non-muscle-invasive (NMI) transitional cell carcinoma (TCC) of the bladder is a common disease that recurs frequently and may progress to more sinister invasive disease. In the absence of a molecular tool that can accurately predict an individual's propensity to tumour recurrence and/or progression, urologists utilise prognostic factors to predict patient outcome. To ascertain the value and ranking of known prognostic factors we performed a MEDLINE search using the MeSH heading bladder neoplasm, with classification, epidemiology and mortality as subheadings. Papers describing significant cohorts of patients (>100) were identified and reviewed to ascertain tumour recurrence and progression rates, along with overall and bladder cancer-specific mortality. Factors affecting tumour recurrence, progression and survival were determined. Tumour recurrence and progression rates varied between 46–70% and 6–56% respectively. Multifocality, previous high tumour recurrence rate, positive 3-month check cystoscopy and tumour size were predictive of tumour recurrence. Tumour grade, multifocality and tumour size were predictive of tumour progression. Overall and bladder cancer-specific survival varied between 8–85% and 56–99.4% respectively, and clearly related to duration of patient follow-up. Grade, stage and previous high tumour recurrence rates predicted patient survival. The data obtained regarding prognostic factors are used to describe a rationale follow-up schedule for patients with NMI TCC of the bladder.