Recurrence in high-risk bladder cancer warrants intense surveillance

Stage T1 disease was associated with higher rates of recurrence, progression and mortality in a cohort of patients with high-grade non–muscle-invasive bladder cancer, according to study results.

Researchers used SEER data to investigate recurrence, progression and bladder cancer-related mortality rates in a cohort of 7,410 patients. Eligible participants had been diagnosed from 1992 to 2002 and were followed until 2007.

Results indicated 2,897 patients (39.1%) experienced recurrence without progression. Another 2,449 (33%) experienced disease progression; of them, 981 died of bladder cancer.

The results of multivariate competing-risks regression analysis indicated recurrence rates of 61.1% at 2 years, 69.5% at 5 years and 74.3% at 10 years.

The analysis showed a 10-year progression rate of 33.3% and 10-year bladder cancer-related mortality rate of 12.3%.

Stage T1 disease was the only variable associated with a higher recurrence rate, according to researchers. Several variables were associated with higher risk of both progression and mortality, including female sex, black race, undifferentiated grade, and stage Tis and T1 disease.

Older age (≥70 years) also was associated with increased risk of bladder cancer-related mortality risk.

“Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer,” the researchers wrote. “Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first 2 years of diagnosis warrants an intense surveillance schedule.”