Bladder-sparing therapy for high-tumor-burden non-muscle invasive bladder cancer: outcomes from high-tumor-burden NMIBC program.

PURPOSE: The management of high-tumor-burden non-muscle invasive bladder cancer remains challenging due to risks of incomplete resection, perioperative complications, and eventual cystectomy. This study aims to evaluate the feasibility and outcomes associated with the implementation of the High-Tumor-Burden NMIBC Program.

METHODS

This multicenter retrospective study analyzed patients from five tertiary care centers who enrolled in the High-Tumor-Burden NMIBC Program between January 2019 and January 2024. Key interventions comprised: (1) endoscopic bladder tumor burden assessment, (2) staged resection for massive lesions, (3) superficial resection for flat-like tumors, (4) targeted detrusor muscle sampling, (5) extraction of tumor with the siphon effect, and (6) intravesical BCG instillations. Survival curves were generated using the Kaplan-Meier method, with differences assessed by the log-rank test.

RESULTS

With a median follow-up time of 2.5 years, complete macroscopic resection was achieved in all patients, with 36 patients (18.2%) receiving a second and 4 patients (2.0%) receiving a third session. During the entire follow-up period, 186 patients (93.9%) preserved their bladders. High-grade recurrence-free survival rates at 1 and 3 years were 92.7% and 86.9%, and progression-free survival rates were 100.0% and 91.1%. Cystectomy-free survival rates at 1 and 3 years were 100% and 95.7%, and overall survival rates were 99.0% and 94.7%.

CONCLUSION

This study suggests the feasibility of implementing the High-Tumor-Burden NMIBC Program, achieving high rates of complete resection and bladder preservation with acceptable oncologic outcomes during intermediate follow-up.