title: High risk bladder cancer: current management and survival.
abstract: OBJECTIVE
  To evaluate the pattern of care in patients with high risk non muscle invasive bladder cancer (NMIBC) in the Comprehensive Cancer Center North-Netherlands (CCCN) and to assess factors associated with the choice of treatment, recurrence and progression free survival rates.
  
  
  METHODS
  Retrospective analysis of 412 patients with newly diagnosed high risk NMIBC. Clinical, demographic and follow-up data were obtained from the CCCN Cancer Registry and a detailed medical record review. Uni and multivariate analysis was performed to identify factors related to choice of treatment and 5 year recurrence and progression free survival.
  
  
  RESULTS
  74/412 (18%) patients with high risk NMIBC underwent a transurethral resection (TUR) as single treatment. Adjuvant treatment after TUR was performed in 90.7% of the patients treated in teaching hospitals versus 71.8% in non-teaching hospitals (p < 0.001). In multivariate analysis, age (60-79 years OR 0.40 and > 80 years OR 0.1 p = 0.001) and treatment in non-teaching hospitals (OR 0.25; p < 0.001) were associated with less adjuvant treatment after TUR. Tumor recurrence occurred in 191/392 (49%) and progression in 84/392 (21.4%) patients. The mean 5-years progression free survival was 71.6% (95% CI 65.5-76.8).
  
  
  CONCLUSIONS
  In this pattern of care study in high risk NMIBC, 18% of the patients were treated with TUR as single treatment. Age and treatment in non-teaching hospitals were associated with less adjuvant treatment after TUR. None of the variables sex, age, comorbidity, hospital type, stage and year of treatment was associated with 5 year recurrence or progression rates.
authors.affiliation: Department of Urology, University Medical Center Groningen, Groningen, The Netherlands. a.m.leliveld@uro.umcg.nl
authors.forename: Anna M
authors.initials: AM
authors.lastname: Leliveld
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: Benjamin H J
authors.initials: BH
authors.lastname: Doornweerd
authors.forename: Michael
authors.initials: M
authors.lastname: Schaapveld
authors.forename: Igle J
authors.initials: IJ
authors.lastname: de Jong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*