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Significance of Bladder Neck Involvement in Risk Substratification of Intermediate-Risk Non-muscle-invasive Bladder Cancer
- Source :
- European urology focus. 7(2)
- Publication Year :
- 2019
-
Abstract
- Intermediate-risk non-muscle-invasive bladder cancer (NMIBC) involves heterogeneous patients, resulting in uncertainty regarding its prognosis and the indication of adjuvant therapy. Previous studies suggested a correlation between tumor location, especially bladder neck involvement (BNI), and patient prognosis of NMIBC.We investigated the role of BNI in risk substratification of intermediate-risk NMIBC patients.This single-institutional study included 436 primary or recurrent intermediate-risk NMIBC patients based on risk stratification in the European Association of Urology guidelines.All patients underwent transurethral resection of the bladder tumor.The primary and secondary endpoints were progression and recurrence, respectively. The associations of BNI with the endpoints were examined using the Kaplan-Meier method and the Cox proportional hazards model.Overall, 205 (47%) patients had multiple tumors and 276 (63%) underwent intravesical therapy. BNI was observed in 53 (12%) patients. During the median follow-up of 42 mo, 12 (3%) and 211 (48%) patients experienced progression and recurrence, respectively. Multivariate analysis showed that BNI was an independent predictor for both progression (hazard ratio 10.98, p0.001) and recurrence (hazard ratio 2.12, p0.001). The progression rate was significantly higher in patients with BNI compared with those without BNI (13% vs 1% at 3 yr and 20% vs 1% at 6 yr; p0.001). Analogous findings were observed for recurrence. The progression rate was more remarkably stratified by BNI in 103 recurrent cases (17% vs 3% at 3 yr and 34% vs 3% at 6 yr in patients with vs without BNI; p0.001). A limitation of this study was its retrospective nature.BNI substratified intermediate-risk NMIBC patients well regarding their risks of progression and recurrence, which could help determine follow-up and therapeutic strategies for these patients.The associations of bladder neck involvement with progression and recurrence were evaluated in patients with intermediate-risk non-muscle-invasive bladder cancer. We found that bladder neck involvement was a good factor for substratifying patients based on their risks of progression and recurrence. Bladder neck involvement can be useful in determining follow-up and therapeutic strategies for intermediate-risk non-muscle-invasive bladder cancer.
- Subjects :
- Oncology
Male
medicine.medical_specialty
Multivariate analysis
Urology
Urinary Bladder
030232 urology & nephrology
03 medical and health sciences
0302 clinical medicine
Bladder neck involvement
Internal medicine
medicine
Adjuvant therapy
Humans
Neoplasm Invasiveness
Neoplasm Metastasis
Aged
Retrospective Studies
Bladder cancer
business.industry
Proportional hazards model
Hazard ratio
Middle Aged
medicine.disease
Urinary Bladder Neoplasms
030220 oncology & carcinogenesis
Disease Progression
Female
Neoplasm Recurrence, Local
Non muscle invasive
business
Intermediate risk
Subjects
Details
- ISSN :
- 24054569
- Volume :
- 7
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- European urology focus
- Accession number :
- edsair.doi.dedup.....51b68834099ddbd55a0cea67e7493ddb