Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France.
Eur Urol Focus. 2024 Jan;10(1):189-196. doi: 10.1016/j.euf.2023.06.012. Epub 2023 Jul 11.
While low-risk non-muscle-invasive bladder cancer (LR-NMIBC) has a low propensity to progress, the risk of recurrence remains high (50% within 4 yr). Guidelines recommend cystoscopic surveillance after resection, but the necessary duration of follow-up is debated.
To determine the risk of recurrence beyond 5 yr after diagnosis in patients with LR-NMIBC, and to identify risk factors of recurrence.
DESIGN, SETTING, AND PARTICIPANTS: In this multicenter retrospective observational study, patients who received their first transurethral bladder tumor resection before 2016 for LR-NMIBC were included. Low risk was defined as a primary, solitary, low grade, Ta bladder tumor measuring <3 cm.
The primary endpoint was determination of the recurrence rates at 1, 2, and 5 yr. The secondary endpoints included overall recurrence-free survival (RFS) and high-risk RFS. A univariate analysis and multivariable logistic regression were performed to assess the risk factors for recurrence over the study period.
The median age of the 577 patients was 70.9 yr, and 126 (21.8%) patients were female. The median follow-up was 69.6 (interquartile range: 58.4) mo, and recurrence was observed in 236 (40.9%) patients. The 1-, 2-, and 5-yr RFS rates were 81.6% (95% confidence interval 78.4-84.9), 72.4% (68.7-76.3), and 59.2% (55-63.8), respectively. Recurrence after 5 yr was observed in 13.1% (28/213). High-risk recurrence, defined as the first recurrence of a high-grade and/or ≥T1 tumor, occurred in 6.2% (36/579) overall and 2.8% (6/213) after 5 yr. The lack of a single postoperative dose of chemotherapy and tumor size >2 cm were prognostic factors of recurrence.
The risk of recurrence in patients with LR-NMIBC decreases progressively after the 1st year and remains low beyond 5 yr. Discontinuation of endoscopic surveillance after 5 yr in patients with LR-NMIBC can be discussed. Treatment with postoperative chemotherapy and tumor size <2 cm may be relevant variables to identify patients who will benefit from cystoscopic follow-up as short as 12 mo.
In this study, we observed that 13% of patients who did not have a recurrence during the first 5 yr following the diagnosis of low-risk non-muscle-invasive bladder cancer will recur after this time point. Discontinuation of cystoscopic surveillance can be discussed after 5 yr in these patients.
虽然低危非肌肉浸润性膀胱癌（LR-NMIBC）进展的倾向较低，但复发的风险仍然很高（4 年内 50%）。指南建议在切除后进行膀胱镜检查监测，但随访的必要持续时间存在争议。
确定 LR-NMIBC 患者诊断后 5 年以上复发的风险，并确定复发的危险因素。
设计、地点和参与者：在这项多中心回顾性观察性研究中，纳入了 2016 年之前接受首次经尿道膀胱肿瘤切除术治疗的 LR-NMIBC 患者。低危定义为原发性、单发、低级别、Ta 膀胱肿瘤，大小<3cm。
主要终点是确定 1、2 和 5 年时的复发率。次要终点包括总复发无进展生存（RFS）和高危 RFS。进行单变量分析和多变量逻辑回归以评估研究期间复发的危险因素。
577 例患者的中位年龄为 70.9 岁，126 例（21.8%）为女性。中位随访时间为 69.6（四分位距：58.4）个月，236 例（40.9%）患者出现复发。1、2 和 5 年的 RFS 率分别为 81.6%（95%置信区间 78.4-84.9）、72.4%（68.7-76.3）和 59.2%（55-63.8）。5 年后观察到 13.1%（28/213）复发。高危复发定义为高级别和/或≥T1 肿瘤的首次复发，总发生率为 6.2%（579 例中有 36 例），5 年后发生率为 2.8%（213 例中有 6 例）。缺乏单次术后化疗和肿瘤大小>2cm 是复发的预后因素。
LR-NMIBC 患者在第 1 年后复发风险逐渐降低，5 年后仍保持较低水平。对于 LR-NMIBC 患者，在 5 年后可以讨论停止膀胱镜检查监测。术后化疗和肿瘤大小<2cm 可能是确定需要进行 12 个月短时间膀胱镜随访的患者的相关变量。
在这项研究中，我们观察到在诊断为低危非肌肉浸润性膀胱癌后的第 5 年内未复发的 13%的患者在该时间点后会复发。在这些患者中，5 年后可以讨论停止膀胱镜监测。
