Mp35-10 Long Term Follow Up and Risk of High-Grade Recurrence in Low-Grade Pta Bladder Cancer Patients

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (MP35)1 May 2024MP35-10 LONG TERM FOLLOW UP AND RISK OF HIGH-GRADE RECURRENCE IN LOW-GRADE PTA BLADDER CANCER PATIENTS Alessio Finocchiaro, Roberto Contieri, Paolo Casale, Alberto Saita, Nicolò Maria Buffi, Giovanni Lughezzani, Nicola Frego, Andrea Gobbo, Giorgio Guazzoni, and Rodolfo Hurle Alessio FinocchiaroAlessio Finocchiaro , Roberto ContieriRoberto Contieri , Paolo CasalePaolo Casale , Alberto SaitaAlberto Saita , Nicolò Maria BuffiNicolò Maria Buffi , Giovanni LughezzaniGiovanni Lughezzani , Nicola FregoNicola Frego , Andrea GobboAndrea Gobbo , Giorgio GuazzoniGiorgio Guazzoni , and Rodolfo HurleRodolfo Hurle View All Author Informationhttps://doi.org/10.1097/01.JU.0001009372.61513.54.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-muscle invasive bladder cancer (NMIBC) is a common diagnosis, with approximately 60% of cases being low-grade (LG) tumors that do not invade the lamina propria (Ta). Despite this, contemporary data on TaLG bladder cancer patients is scarce. Hence, the primary objective of this study was to investigate the recurrence rate and identify factors influencing the risk of upgrade and upstage in a contemporary large series of TaLG bladder cancer patients. The goal is to provide suggestions for follow-up schedules and management options in this setting. METHODS: This single-center retrospective observational study included patients treated at a high-volume tertiary care hospital, diagnosed with pTa LG that experienced at least one recurrence. The follow-up schedule and the disease management were in line with the European Association of Urology guidelines. The primary endpoint was high-grade (HG) recurrence. Follow-up was calculated with inverse Kaplan-Meier (KM) methods. The Cox regression model was used to predict HG recurrence. KM curve was applied for time to HG recurrence. RESULTS: A total of 184 TaLG patients were included. The median age was 68 (IQR 60-74), with a median follow-up of 73 months (IQR 46-114). Of them, 52 (28.26%) received at least one course of intravesical therapy during the follow-up. A total of 15 patients developed an HG recurrence. The median number of LG recurrences per patient was 2 (IQR 1-3.5). The median time to HG recurrence was 41 months (IQR 27-102). HG-recurrence-free survival was 98% (IQR 95-99), 94% (IQR 89-97) and 91% (IQR 84-95) at 24, 72 and 96 months. Multivariable Cox regression analyses controlled for smoking, grade, age at TUR, previous instillations, and number of previous LG recurrences revealed that age at TUR Hazard Ratio (HR) 1.09, IQR 1.03-1.16, p<0.05 and number of previous LG recurrences (HR 1.69, IQR 1.30-2.20, p<0.01) emerged to be statistically significantly associated with a higher risk of HG recurrence. Whereas previous intravesical instillations are protective against HG recurrence (HR: 0.15, IQR 0.03-0.81, p<0.05). CONCLUSIONS: According to our results, grade progression in pTa LG patients is low, especially within the first 2 years, with 94% of the patients without progression at 24 months. We also highlighted that age at first TUR and the number of previous LG recurrences increase whereas previous intravesical instillation decreases the risk of HG progression, suggesting that is fundamental to accurately distinguish patients, based on their disease history, in the follow-up schedule. These findings could guide clinical decision-making and counsel patients with LG NMIBC about their long-term risk of progression. Furthermore, our findings reinforce that conservative approaches, such as active surveillance or in-office fulguration, are reasonable choices in this setting and should be encouraged. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e584 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alessio Finocchiaro More articles by this author Roberto Contieri More articles by this author Paolo Casale More articles by this author Alberto Saita More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Nicola Frego More articles by this author Andrea Gobbo More articles by this author Giorgio Guazzoni More articles by this author Rodolfo Hurle More articles by this author Expand All Advertisement PDF downloadLoading ...