Contemporary outcomes in non-muscle-invasive bladder cancer: a large European multicentre study.
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Longoni Mattia, Scilipoti Pietro, De Angelis Mario, Zaurito Paolo, Tremolada Giovanni, Santangelo Alfonso, Simone Giuseppe, Mastroianni Riccardo, Lonati Chiara, Zamboni Stefania, Suardi Nazareno, Marcq Gautier, Szostek Aleksandra, Caño Velasco Jorge, Puentedura Alfonso Lafuente, Subiela José Daniel, Durán Pedro Del Olmo, Ślusarczyk Aleksander, Karakiewicz Pierre I, Pradere Benjamin, Soria Francesco, Gontero Paolo, Rouprêt Morgan, Montorsi Francesco, Salonia Andrea, Briganti Alberto, Moschini Marco, European Association of Urology ‐ Young Academic Urologists (EAU‐YAU), Urothelial Carcinoma Working Group
Аннотация
PATIENTS AND METHODS: A total of 1918 patients with NMIBC treated with transurethral resection of bladder tumour (TURBT) were retrospectively identified from six tertiary-referral European centres (2015-2022). Patients were stratified according to European Association of Urology 2021 criteria into low- (LR), intermediate- (IR), high- (HR) and very high-risk (VHR) categories. Cumulative incidence plots and multivariable competing risks regression models addressing 5-year rates of high-grade (HG) recurrence and progression were fitted. Sensitivity analyses focused on patients receiving intravesical instillations and tested for the effect of adequate course (Bacillus Calmette-Guérin: five or more induction + two or more maintenance instillations; mitomycin C: complete induction + ≥11 maintenance instillations).
RESULTS: Of all NMIBC patients identified, 467 (24.3%) were LR vs 582 (30.3%) IR vs 739 (38.5%) HR vs 130 (6.8%) VHR. The median (interquartile range) follow-up after TURBT was 26 (12-46) months. The 5-year HG recurrence rates were 7.2% in LR vs 17.3% in IR vs 26.7% in HR vs 30.9% in VHR patients, resulting in a three-, five- and seven-fold higher risk of IR, HR and VHR, respectively, relative to LR (all P < 0.001). The 5-year progression rates were 3.9% in LR vs 5.2% in IR vs 13.6% in HR vs 31.6% in VHR patients, resulting in a six- and nine-fold higher risk for HR and VHR, respectively, relative to LR (all P < 0.001). In all, 1001 (52.2%) patients underwent intravesical instillations. Those receiving adequate instillation course (244/1001 [24.3%]) had lower HG-recurrence (hazard ratio 0.3, P < 0.001) and progression (hazard ratio 0.2, P = 0.001) risk.
CONCLUSIONS: Patients with HR/VHR NMIBC face significantly higher HG recurrence and progression risks. While tailored treatment strategies are needed, adherence to adequate instillation course remains crucial for optimising oncological outcomes.