title: Recurrence of high-risk bladder cancer: a population-based analysis.
abstract: BACKGROUND
  Patients with bladder cancer are apt to develop multiple recurrences that require intervention. The recurrence, progression, and bladder cancer-related mortality rates were examined in a cohort of individuals with high-grade non-muscle-invasive bladder cancer.
  
  
  METHODS
  Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, subjects were identified who had a diagnosis of high-grade, non-muscle-invasive disease in 1992 to 2002 and who were followed until 2007. Multivariate competing-risks regression analyses were then used to examine recurrence, progression, and bladder cancer-related mortality rates.
  
  
  RESULTS
  Of 7410 subjects, 2897 (39.1%) experienced a recurrence without progression, 2449 (33.0%) experienced disease progression, of whom 981 succumbed to bladder cancer. Using competing-risks regression analysis, the 10-year recurrence, progression, and bladder cancer-related mortality rates were found to be 74.3%, 33.3%, and 12.3%, respectively. Stage T1 was the only variable associated with a higher rate of recurrence. Women, black race, undifferentiated grade, and stage Tis and T1 were associated with a higher risk of progression and mortality. Advanced age (≥ 70) was associated with a higher risk of bladder cancer-related mortality.
  
  
  CONCLUSIONS
  Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within 10 years of their diagnosis. Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer. Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first 2 years of diagnosis warrants an intense surveillance schedule.
authors.affiliation: Department of Urology, Health Services Research Group, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Bassett
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Jan M
authors.initials: JM
authors.lastname: Hanley
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D016017:Odds Ratio; D012307:Risk Factors; D018426:SEER Program; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000473:pathology*
keywords: bladder cancer mortality; progression; quality of healthcare; recurrence; urinary bladder neoplasms