Disease specific mortality in patients with low risk bladder cancer and the impact of cystoscopic surveillance
Linton KD, Rosario DJ, Thomas F, Rubin N, Goepel JR, Abbod MF, Catto JW. J Urol. 2012 Sep 24. pii: S0022-5347(12)04977-4. doi: 10.1016/j.juro.2012.09.084. [Epub ahead of print]

Source

The Academic Urology Unit and Institute for Cancer Studies, University of Sheffield, Sheffield, UK.

Abstract

PURPOSE:

To determine the risk of disease specific mortality (DSM) in patients with primary low-risk non-invasive (G1pTa) bladder cancer. To compare this to DSM for age and gender matched general populations.

PATIENTS AND METHODS:

We identified all patients with primary low-risk cancer at our institution. We excluded those with adverse pathological features and matched histopathology, pharmacy, hospital episode and Cancer Registry records. We reviewed case notes for patients with subsequent muscle invasion (progression) or DSM. Patients underwent post-resection surveillance and treatment using standard regimens. The national and regional DSM rates were calculated from appropriate data.

RESULTS:

In total, 699 patients met our inclusion criteria (median follow up 61 months (IQ range 24-105)). Seventeen patients (2.4%) died from bladder cancer, including 13/14 that progressed to muscle invasion and 4/19 with grade-progression to high-grade non-muscle invasive disease. Low-grade dysplasia in the initial resection specimen and tumor weight were associated with DSM (Cox regression analyses p<0.003). DSM in these patients was 5 times the background rate for matched populations. Limitations to this study include its retrospective nature and the low frequency of adverse events.

CONCLUSIONS:

Patients with low risk bladder cancer rarely progress to muscle invasion but do have a higher risk of DSM than the general population. Current surveillance regimens appeared ineffective in detecting progression in time to alter prognosis.