title: Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study.
abstract: OBJECTIVE
  To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression.
  
  
  RESULTS
  With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy.
  
  
  CONCLUSIONS
  A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.
authors.affiliation: Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, Ajou University College of Medicine, Suwon, Korea.
authors.forename: Se Joong
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Urology, The Catholic University College of Medicine, Seoul, Korea.
authors.forename: Sung Hoo
authors.initials: SH
authors.lastname: Hong
authors.affiliation: Department of Urology, Konkuk University College of Medicine, Chungju, Korea.
authors.forename: Hong Sup
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea.
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon
authors.affiliation: Department of Urology, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Jin Seon
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.affiliation: Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
authors.forename: Kwan Joong
authors.initials: KJ
authors.lastname: Joo
authors.affiliation: Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
authors.forename: Han Jong
authors.initials: HJ
authors.lastname: Ahn
authors.affiliation: Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Urology, Inha University College of Medicine, Incheon, Korea.
authors.forename: Do Hwan
authors.initials: do H
authors.lastname: Seong
authors.affiliation: Department of Urology, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.affiliation: Department of Urology, Chonbuk National University College of Medicine, Jeonju, Korea.
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea. hllee61@hanmail.net.
authors.forename: Hyung Lae
authors.initials: HL
authors.lastname: Lee
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy
keywords: Urinary bladder neoplasm; disease progression; prognosis; recurrence