High-risk bladder cancer: is a change in surveillance strategy necessary?

  • Rezaee ME & al.
  • PLoS ONE
  • 1 Jan 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • A low-intensity cystoscopic surveillance approach to follow-up patients with high-risk, nonmuscle invasive bladder cancer (NMIBC) after surgery appears feasible; however, randomized trials are warranted before incorporating it into practice.

Why this matters

  • Patients with NMIBC need to undergo surveillance cystoscopy after transurethral resection and possible intravesical therapy for assessment of disease recurrence over time.

Study design

  • Retrospective cohort study including 1542 patients (age, >65 years) from US Department of Veterans Affairs diagnosed with high-risk NMIBC between 2005 and 2011 and followed up through 2014.
  • Patients were categorized into:
    • Low-intensity surveillance: 1-5 cystoscopies.
    • High-intensity surveillance: 6 cystoscopies.
  • Funding: None disclosed.

Key results

  • With low- vs high-intensity surveillance: 
    • Fewer transurethral resections: 37 vs 99 per 100 person-years (P<.001>
    • No significant difference in risk for bladder cancer death at 5 years:
      • Cumulative incidence (CIn): 8.4% vs 9.1% (P=.61).
    • No increased risk (CIn) for bladder cancer death at 5 years with: 
      • Ta: 5.7% vs 8.2% (P=.24). 
      • T1: 10.2% vs 9.1% (P=.58). 
    • Decreased risk for progression to invasive disease (T1/T2) or death at 5 years: 
      • CIn: 19.3% vs 31.3% (P=.002).

Limitations

  • Findings may be subject to unmeasured confounding. 
  • The potential influence of adjunct testing/imaging on surveillance cystoscopy practices was not assessed.