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Recurrence Mechanisms of Non-Muscle-Invasive Bladder Cancer — a Clinical Perspective

Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15–61%, and a 5-year recurrence rate of 31–78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.

Jeremy Yuen-Chun Teoh,1,2  Ashish M. Kamat,3 Peter C. Black,4 Petros Grivas,5,6 Shahrokh F. Shariat7,8,9,10,11,12 and Marek Babjuk7,12

  1. Jeremy Yuen-Chun Teoh S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
  2. European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, Netherlands
  3. The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  4. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  5. Division of Oncology, Department of Medicine, University of Washington, Washington, USA
  6. Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
  7. Department of Urology, Medical University of Vienna, Vienna, Austria
  8. Department of Urology, Weill Cornell Medical College, New York, NY, USA
  9. Department of Urology, University of Texas Southwestern, Dallas, TX, USA
  10. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  11. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
  12. Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic

Source: Teoh, J.YC., Kamat, A.M., Black, P.C. et al. Recurrence mechanisms of non-muscle-invasive bladder cancer — a clinical perspective. Nat Rev Urol (2022). https://doi.org/10.1038/s41585-022-00578-1