Lachand A T, Texier J, Texier P
Clinique Sarrette, Paris, France.
Prog Urol. 2001 Jun;11(3):466-71.
To identify prognostic factors (risk of recurrence and risk of progression) and define the rules for the surveillance of stage Ta superficial bladder cancers, based on the follow-up of a homogeneous patient series.
138 Ta bladder cancers were recruited from 1975 to 1995 and regularly followed by the same urologist. The follow-up was 1 to 18 years with a mean of 66 months and a median of 60 months.
30% of patients developed no recurrence (mean follow-up: 52 months). 70% developed one or several recurrences (mean follow-up: 80 months): 46% of Ta recurrences without progression and 24% of T > or = 1, with 10% of T > 1 recurrencesed. 13/138 patients died from bladder cancer, including 11 patients in less than 10 years. The risk of recurrence and the risk of progression were significantly correlated with: the macroscopic appearance of the cancer: size, number and extent of implantations, sessile or pedunculated nature, its site: slightly more serious on the fixed part of the organ, its clinical course assessed over the first 12 months: in patients without recurrence at 12 months: the risk of recurrence decreased from 70% to 35% the risk of deterioration decreased from 24% to 10%. However, this risk persisted in the long term: after more than 5 years without recurrence, 2 patients developed fatal recurrences, 11 and 15 years after the initial treatment.
Although superficial, Ta bladder cancers are serious cancers. The risk of recurrence and progression justify close surveillance in the year following diagnosis. Subsequently, the frequency of follow-up can be adapted to the specific course of each case, but, regardless of these modalities, long-term (indefinite?) surveillance is recommended.
