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Significance of Bladder Neck Involvement in Risk Substratification of Intermediate-Risk Non-muscle-invasive Bladder Cancer

Authors :
Kazutaka Saito
Hajime Tanaka
Yoh Matsuoka
Yuma Waseda
Shohei Fukuda
Shingo Moriyama
Soichiro Yoshida
Toshiki Kijima
Hiroshi Fukushima
Sho Uehara
Minato Yokoyama
Junichiro Ishioka
Yasuhisa Fujii
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.

Details

ISSN :
24054569
Volume :
7
Issue :
2
Database :
OpenAIRE
Journal :
European urology focus
Accession number :
edsair.doi.dedup.....51b68834099ddbd55a0cea67e7493ddb