High grade non-muscle invasive bladder cancer (HG-NMIBC) exposes to a high risk of recurrence and progression. Standard of care includes repeated trans-urethral resection of bladder tumor (reTURBT) and bacillus Calmette-Guérin (BCG) therapy. Not following Standard of care (SOC) may be associated with a worse prognosis. We aimed to compare prognosis outcomes of patients with primary HG-NMIBC according to the respect of the SOC or not.
We conducted an eleven-year retrospective observational study including all patients undergoing initial bladder resection for de novo HG-NMIBC at our institution. Exclusion criteria were prior urothelial carcinoma histology, low grade NMIBC or ≥ T2 staging. Four groups were formed according to the treatment received.
Among 164 patients, 44.5% received standard of care, 18.3% received only BCG-therapy, 16.5% benefited only from reTURBT and 20.7% did not receive treatment. Upstaging to T2 tumor was found in 6% of reTURBT specimens. Presence of residual tumor (RT) on re-TURBT (p < 10-4) and having benefited from SOC (p=0.016) impacted recurrence-free survival. Progression-free survival was impacted by presence of RT (p=0.001) but not by SOC (p=0.284).
Performing standard of care on patients with HG-NMIBC is associated with a lower risk of recurrence. We believe SOC should be provided for all HG-NMIBC patients, especially those with poor prognostic factors such as T1 tumor, or multiplicity or largeness of the bladder tumor.
The French journal of urology. 2024 Dec 03 [Epub ahead of print]
Thomas Palkowski, Frédéric Bibeau, Antoine Thiery-Vuillemin, François Kleinclauss, Alexandre Frontczak
Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000 Besançon, France; University of Franche-Comté, 25000 Besançon, France., University of Franche-Comté, 25000 Besançon, France; Department of Pathology, University Hospital of Besançon, 25000 Besançon, France., University of Franche-Comté, 25000 Besançon, France; Department of Medical Oncology, University Hospital of Besançon, 25000 Besançon, France; INSERM UMR 1098, 25000 Besançon, France., Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000 Besançon, France; University of Franche-Comté, 25000 Besançon, France; Nanomedicine Lab, Imagery and Therapeutics.EA 4662, France., Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000 Besançon, France; University of Franche-Comté, 25000 Besançon, France; Nanomedicine Lab, Imagery and Therapeutics.EA 4662, France. Electronic address: .