Aspects of Recurrence and Progression in Ta/T1 Urinary Bladder Cancer

Abstract: Aims: To evaluate different aspects of recurrence and, when appropriate, progression in primary Ta/T1 urinary bladder cancer.Patients and methods: All evaluable patients diagnosed with primary Ta/T1 urinary bladder cancer in Linköping and Norrköping between 1992 and 2007 were included prospectively in the study cohort. Histopathology results were classified according to the TNM system and were reviewed by a reference pathologist using the WHO 1999 criteria (except in the studies reported in Papers I and IV). Risk factors for local recurrence were evaluated using data from the period 1992–2001 (Paper I). Tumour size (Paper II) and bladder wash cytology (Paper III) at primary diagnosis were assessed regarding the impact on recurrence and progression, and tumour presence in the marginal resection in primary and recurrent Ta/T1 bladder cancer was investigated considering effects on recurrence in patients treated between 2001 and 2010 (Paper IV). Furthermore, surgical experience measured as training status (resident or specialist) and surgical volume (both during the study period and lifetime) were analysed regarding their influence on recurrence and progression (Paper V).Results: Tumour size > 30 mm (p < 0.001) and multiplicity (p = 0.021) were significantly associated with local recurrence (Paper I). Tumour sizes 16–30 mm and > 30 mm were correlated with recurrence (p = 0.003 and p < 0.001, respectively) but not with progression (Paper II). High-grade malignant bladder wash cytology proved to be predictive of both recurrence (p < 0.001) and progression (p = 0.036) as was shown in Paper III. A tumour-positive marginal resection was related to overall (p < 0.001) and local (p < 0.001) recurrence (Paper IV). Transurethral resection of bladder tumours performed by residents was associated with recurrence (p = 0.004) but not with progression. No differences in relation to either recurrence or progression were found for the surgical volume approach at the chosen cut-offs (Paper V).Conclusions: The present studies identified new risk factors for recurrence (tumours > 15 mm, high-grade bladder wash cytology at diagnosis, tumour-positive marginal resection, and surgery performed by residents) and progression (local recurrence and high-grade malignant bladder wash cytology at diagnosis), which in the future may be integrated into follow-up schedules or risk profiles for patients with Ta/T1 urinary bladder cancer.