title: Late recurrence and progression after a long tumor-free period in primary Ta and T1 bladder cancer.
abstract: OBJECTIVE
  To determine the probability and risk factors of recurrence and progression (to T2 or worse) after a long tumor-free period in patients with superficial (stage Ta and T1) bladder cancer.
  
  
  METHODS
  A consecutive series of 100 patients with superficial bladder cancer who remained tumor-free for longer than 4 years after initial treatment were reviewed. The rates of recurrence and progression were statistically assessed and the significance of risk factors was determined.
  
  
  RESULTS
  Of the 100 patients, 24 (24. 0%) recurred within 15 years after the initial treatment. The 10- and 15-year recurrence-free rates were 76.0 and 59.6%, respectively. Among the clinicopathological variables examined, intravesical chemotherapy was determined by a log-rank test to be a significant unfavorable risk factor for late recurrence (p < 0.001). Progression of the tumor occurred in 5 patients. Four variables including presence of multiple tumors, involvement of the bladder neck, positive urine cytology, and intravesical chemotherapy were found by a univariate analysis to be significant risk factors for late progression (p < 0.05). Among these factors, initial presence of multiple tumors (3 or more) was determined by a multivariate analysis to be an independent risk factor for late progression.
  
  
  CONCLUSIONS
  Recurrence and progression continue to occur in patients with superficial bladder cancer even after long periods of dormancy. Regular follow-up urological assessments should be continued until at least 15 years of tumor-free existence, especially in patients treated by intravesical chemotherapy or those initially having multiple tumors.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan. y-fujii.uro@med.tmd.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Fujii
authors.forename: I
authors.initials: I
authors.lastname: Fukui
authors.forename: K
authors.initials: K
authors.lastname: Kihara
authors.forename: T
authors.initials: T
authors.lastname: Tsujii
authors.forename: Y
authors.initials: Y
authors.lastname: Kageyama
authors.forename: H
authors.initials: H
authors.lastname: Oshima
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012907:Smoking; D015996:Survival Rate; D013995:Time; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality