title: The natural history of secondary muscle-invasive bladder cancer.
abstract: BACKGROUND
  The management of patients with high-grade non muscle invasive bladder cancer (NMIBC) brings diagnostic and therapeutic challenges. In the current study, we sought to study the natural history of progression to "secondary" muscle-invasive bladder cancer (MIBC)-cancer that developed during follow up of patients presenting with non-muscle invasive bladder cancer (NMIBC).
  
  
  METHODS
  Between 1998 and 2008, 760 patients were treated for bladder cancer. Primary MIBC (>=T2) tumors (present upon presentation) were diagnosed in 114 patients. All patients with high-grade NMIBC were treated with intravesical BCG. Mean follow-up was 44 months.
  
  
  RESULTS
  Forty patients (6.1%) developed secondary MIBC after a mean period of 21 months from initial diagnosis of bladder cancer. The 2- and 5-year disease-specific survival rates were better for patients with secondary MIBC (90% and 56% compared to 69% and 42% for patients with primary disease, p=0.03). The Kaplan-Meier curves of the two groups were parallel but displaced by approximately 2 years.
  
  
  CONCLUSIONS
  In the current series, MIBC progression occurred among initially presenting patients with NMIBC in 6.1%. In most patients, the initial diagnosis of NMIBC is correct and muscle invasion occurs after a mean period of about 2 years. This supports a non-radical approach in patients with high-grade T1, Ta or Tis. Meticulous follow-up with liberal biopsy of any suspicious lesion may provide early diagnosis of invasive disease.
authors: Department of Urology, Hadassah University Medical Center, Jerusalem, Israel.
authors: Guy
authors: G
authors: Hidas
authors: Dov
authors: D
authors: Pode
authors: Amos
authors: A
authors: Shapiro
authors: Ran
authors: R
authors: Katz
authors: Liat
authors: L
authors: Appelbaum
authors: Galina
authors: G
authors: Pizov
authors: Kevin C
authors: KC
authors: Zorn
authors: Ezekiel H
authors: EH
authors: Landau
authors: Mordechai
authors: M
authors: Duvdevani
authors: Ofer N
authors: ON
authors: Gofrit
mesh_terms: D000368:Aged; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D019042:Muscle Neoplasms / Q000401:mortality* / Q000473:pathology*; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology*; D012307:Risk Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology*
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