title: Previous Bladder Cancer History in Patients with High-Risk, Non-muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History.
abstract: OBJECTIVE
  The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guérin (BCG) and to evaluate their natural history.
  
  
  METHODS
  Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups.
  
  
  RESULTS
  A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival.
  
  
  CONCLUSIONS
  Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Lampros P
authors.initials: LP
authors.lastname: Mitrakas
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Ioannis V
authors.initials: IV
authors.lastname: Zachos
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Vassileios P
authors.initials: VP
authors.lastname: Tzortzis
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Gravas
authors.affiliation: Department of Transfusion Medicine, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Erasmia C
authors.initials: EC
authors.lastname: Rouka
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Dimitropoulos
authors.affiliation: Department of Pathology, Agios Andreas Hospital, Patras, Greece.
authors.forename: Gerasimos P
authors.initials: GP
authors.lastname: Vandoros
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Karatzas
authors.affiliation: Department of Urology, University of Thessaly, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Melekos
authors.affiliation: Department of Biological Chemistry, Medical School, University of Athens, Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papavassiliou
keywords: Disease progression; High-risk; Non-muscle-invasive bladder cancer; Previous bladder cancer history; Recurrence