Transcript Muscle invasion and disease specific mortality in patients with low

MUSCLE INVASION
AND DISEASE
SPECIFIC MORTALITY IN PATIENTS
WITH LOW RISK BLADDER CANCER:
TIME TO CHANGE FOLLOW
UP?
Linton KD, Thomas F, Rubin N, Rosario DJ, Catto JW
Sheffield Teaching Hospitals
INTRODUCTION
Low grade bladder cancer accounts for 30% of
bladder cancers at diagnosis.
 Progression to muscle invasion or metastases is
rare.
 Superficial bladder cancer is one of the most
expensive malignancies to treat.
 We hypothesized that patients with initial G1pTa
bladder cancer would have a similar disease
specific mortality to their age and gender
matched populations.
 If this is correct it could have consequences for
clinical follow up

• All G1pTa
1994 to Dec
2009
•Pharmacy,
hospital episode,
histopathology
and cancer
registry records
checked
•Notes reviewed
of all
progressions to
T2 or death
from bladder
cancer
•National and
regional DSM
calculated
PATIENTS AND METHODS
3,633 primary TCC bladder
699 (19%) primary
G1pTa
33 progress to high
grade NMIBC
14 progress to MIBC
6 radical
cystectomy
3 radical
radiotherapy
8 died from
metastatic TCC
1 disease free post
cystectomy
Inclusion criteria :
•Primary G1pTa
•No adverse features
•No CIS
•No other malignancy
•Follow up of at least one
cystoscopy
4 died from metastatic
TCC
5 died from metastatic
TCC
RESULTS
699 (19%) patients – 67.8% male
 Mean age 69.4 years
 Median follow up 61 months



50% minimum follow up 5 years
Overall recurrence 28.5%
3% at three months
 7.8% at twelve months
 tumour weight was the only pathological parameter
associated with recurrence

PROGRESSION
699 primary G1pTa
9 annual
cystoscopy
33 (4.7%) progress to
high grade NMIBC
Median time 35.7 months
14 (2%) progress to
MIBC
Median time 75 months
5 symptoms
Recurrence was associated
with progression on
multivariate analysis
Low grade dysplasia and
tumour weight associated
with DSM
1-15 cystoscopies needed to
detect each progression
DSM 5x regional and 6x
national rates
PROGRESSION - 3 PATTERNS OF DISEASE
PROGRESSION
Misclassification –
median progression
12.4 months
 Early progression –
(gradual upstaging)
median progression
59.3 months
 Delayed
progression – (long
dormant period)
median progression 98
months

Follow up months
COSTS TO THE NHS Recurrence
Grade progression
£4809 per recurrence
£100,989 per event
£257,625 per event
Stage progression
CONCLUSIONS
This cohort has a 5x risk of BCSM compared to
the background population
 Current follow up regimes have failed to alter the
natural history in all but one patient
 Alternative strategies are needed, ?regular
cytology, ?urinary biomarkers, ?better patient
education
