title: Local recurrence and progression of non-muscle-invasive bladder cancer in Sweden: a population-based follow-up study.
abstract: OBJECTIVE
  The aim of this study was to investigate recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) in a large population-based setting.
  
  
  METHODS
  Patients with bladder cancer (stage Ta, T1 or carcinoma in situ) diagnosed in 2004-2007 (n = 5839) in Sweden were investigated 5 years after diagnosis using a questionnaire. Differences in time to recurrence and progression were analysed in relation to age, gender, tumour stage and grade, intravesical treatment, healthcare region, and hospital volume of NMIBC patients (stratified in three equally large groups).
  
  
  RESULTS
  Local bladder recurrence and progression occurred in 50 and 9% of the patients, respectively. The rate of local recurrence was 56% in the southern healthcare region compared to 37% in the northern region. A multivariate Cox proportional hazards model, adjusting for age, gender, tumour stage and grade, intravesical treatment, healthcare region and hospital volume, showed that recurrence was associated with TaG2 and T1 disease, no intravesical treatment and treatment in the southern healthcare region, but indicated a lower risk of recurrence in the northern healthcare region. Adjusting for the same factors in a multivariate analysis suggested that increased relative risk of progression correlated with older age, higher tumour stage and grade, and diagnosis in the Uppsala/Örebro healthcare region, whereas such risk was decreased by intravesical treatment (relative risk 0.72, 95% confidence interval 0.55-0.93, p = 0.012).
  
  
  CONCLUSIONS
  The incidence of NMIBC recurrence and progression was found to be high in Sweden, and important disparities in outcome related to care patterns appear to exist between different healthcare regions.
authors.affiliation: Department of Urology, Skåne University Hospital, Lund-Malmö , Malmö , Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
authors.forename: Oskar
authors.initials: O
authors.lastname: Hagberg
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini Aliabad
authors.forename: Georg
authors.initials: G
authors.lastname: Jancke
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Hanna
authors.initials: H
authors.lastname: Åberg
authors.forename: Staffan
authors.initials: S
authors.lastname: Jahnson
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*; D013520:Urologic Surgical Procedures
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D001500:BCG Vaccine
keywords: Bladder cancer; non-muscle-invasive; progression; recurrence