Analysis of Intravesical Recurrence After Bladder-preserving Therapy for Muscle-invasive Bladder Cancer.
OBJECTIVE
The aim of the present study was to analyze the pattern of recurrences after bladder-preserving therapy for muscle-invasive bladder cancer.


METHODS
The subjects were 77 patients with T2-3N0M0 bladder cancer whose bladder was preserved by intra-arterial chemotherapy and radiation. The patterns of the first recurrences were retrospectively analyzed.


RESULTS
With a median follow-up of 38.5 months, 17 patients (22.1%) experienced intravesical recurrence without metastasis, 14 (82.4%) of which were cases of non-muscle-invasive bladder cancer recurrence and 3 (17.6%) of which were muscle-invasive bladder cancer recurrences. Muscle-invasive bladder cancer recurred at the same site as the initial tumor site in all three cases, whereas non-muscle-invasive bladder cancer recurred at different sites in 64% of the patients in that group. The peak hazard of the non-muscle-invasive bladder cancer recurrence was observed at around a year after treatment. Recurrent non-muscle-invasive bladder cancer was of a significantly lower histological grade with lower Ki-67-labeling indices than the initial muscle-invasive bladder cancer. Twelve (85.7%) of 14 patients with non-muscle-invasive bladder cancer recurrence achieved disease-free status. The multivariate analysis revealed that multiplicity, grade and tumor size were significantly correlated with the recurrence (P= 0.0001, 0.0442 and 0.0412, respectively).


CONCLUSIONS
Most of the recurrences after bladder-preserving therapy were cases of non-muscle-invasive bladder cancer. The recurrence pattern and characteristics of the tumors did not differ from those of primary non-muscle-invasive bladder cancer. Patients with high-risk factors would be candidates for prophylactic intravesical therapy for non-muscle-invasive bladder cancer recurrence.
Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan.
Mizuki
M
Onozawa
Naoto
N
Miyanaga
Shiro
S
Hinotsu
Jun
J
Miyazaki
Takehiro
T
Oikawa
Tomokazu
T
Kimura
Ei-Ichiro
E
Takaoka
Koji
K
Kawai
Toru
T
Shimazui
Hideyuki
H
Sakurai
Hiroyuki
H
Nishiyama
Hideyuki
H
Akaza
D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000032:analysis; D019496:Cancer Vaccines / Q000008:administration & dosage; D049109:Cell Proliferation; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007261:Infusions, Intra-Arterial; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
D001500:BCG Vaccine; D014408:Biomarkers, Tumor; D019496:Cancer Vaccines; D019394:Ki-67 Antigen; D002945:Cisplatin; D008727:Methotrexate