Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors

Tumor recurrence and worsening progression

Hiroaki Kobayashi, Eiji Kikuchi, Shuji Mikami, Takahiro Maeda, Nobuyuki Tanaka, Akira Miyajima, Ken Nakagawa, Mototsugu Oya

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Methods. We retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years. Results: Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence. Conclusions: Multiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis.

Original languageEnglish
Article number5
JournalBMC Urology
Volume14
Issue number1
DOIs
Publication statusPublished - 2014 Jan 8

Fingerprint

Urinary Bladder Neoplasms
Recurrence
Neoplasms
Intravesical Administration
Urinary Tract
Cystoscopy
Hematuria
Urinary Bladder
Multivariate Analysis

Keywords

  • Bladder cancer
  • Intravesical instillation
  • Progression
  • Recurrence

ASJC Scopus subject areas

  • Urology
  • Reproductive Medicine
  • Medicine(all)

Cite this

Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors : Tumor recurrence and worsening progression. / Kobayashi, Hiroaki; Kikuchi, Eiji; Mikami, Shuji; Maeda, Takahiro; Tanaka, Nobuyuki; Miyajima, Akira; Nakagawa, Ken; Oya, Mototsugu.

In: BMC Urology, Vol. 14, No. 1, 5, 08.01.2014.

Research output: Contribution to journalArticle

@article{56edf7c368014b7db191b169ce5d926a,
title = "Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: Tumor recurrence and worsening progression",
abstract = "Background: We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Methods. We retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years. Results: Tumor recurrence and WP occurred in 82 (43.2{\%}) and 21 (11.1{\%}) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence. Conclusions: Multiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis.",
keywords = "Bladder cancer, Intravesical instillation, Progression, Recurrence",
author = "Hiroaki Kobayashi and Eiji Kikuchi and Shuji Mikami and Takahiro Maeda and Nobuyuki Tanaka and Akira Miyajima and Ken Nakagawa and Mototsugu Oya",
year = "2014",
month = "1",
day = "8",
doi = "10.1186/1471-2490-14-5",
language = "English",
volume = "14",
journal = "BMC Urology",
issn = "1471-2490",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors

T2 - Tumor recurrence and worsening progression

AU - Kobayashi, Hiroaki

AU - Kikuchi, Eiji

AU - Mikami, Shuji

AU - Maeda, Takahiro

AU - Tanaka, Nobuyuki

AU - Miyajima, Akira

AU - Nakagawa, Ken

AU - Oya, Mototsugu

PY - 2014/1/8

Y1 - 2014/1/8

N2 - Background: We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Methods. We retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years. Results: Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence. Conclusions: Multiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis.

AB - Background: We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Methods. We retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years. Results: Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5 months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p < 0.001, HR: 2.97) and absence of intravesical instillation (IVI) (p < 0.001, HR: 2.88) were significant risk factors for tumor recurrence while multiple tumor was the only risk factor for WP (p = 0.001, HR: 5.26). After a 5-year tumor-free period, 9 patients experienced late recurrence in years 5 and 10 and were diagnosed at a follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence. Conclusions: Multiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis.

KW - Bladder cancer

KW - Intravesical instillation

KW - Progression

KW - Recurrence

UR - http://www.scopus.com/inward/record.url?scp=84892165614&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892165614&partnerID=8YFLogxK

U2 - 10.1186/1471-2490-14-5

DO - 10.1186/1471-2490-14-5

M3 - Article

VL - 14

JO - BMC Urology

JF - BMC Urology

SN - 1471-2490

IS - 1

M1 - 5

ER -