Analysis of Intravesical Recurrence After Bladder-preserving Therapy for Muscle-invasive Bladder Cancer.

Mizuki Onozawa, Naoto Miyanaga, Shiro Hinotsu, Jun Miyazaki, Takehiro Oikawa, Tomokazu Kimura, Ei-Ichiro Takaoka, Koji Kawai, Toru Shimazui, Hideyuki Sakurai, Hiroyuki Nishiyama, Hideyuki Akaza

Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan.

Japanese journal of clinical oncology 2012 Sep

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The aim of the present study was to analyze the pattern of recurrences after bladder-preserving therapy for muscle-invasive bladder cancer. The subjects were 77 patients with T2-3N0M0 bladder cancer whose bladder was preserved by intra-arterial chemotherapy and radiation. The patterns of the first recurrences were retrospectively analyzed. With a median follow-up of 38.5 months, 17 patients (22.1%) experienced intravesical recurrence without metastasis, 14 (82.4%) of which were cases of non-muscle-invasive bladder cancer recurrence and 3 (17.6%) of which were muscle-invasive bladder cancer recurrences. Muscle-invasive bladder cancer recurred at the same site as the initial tumor site in all three cases, whereas non-muscle-invasive bladder cancer recurred at different sites in 64% of the patients in that group. The peak hazard of the non-muscle-invasive bladder cancer recurrence was observed at around a year after treatment. Recurrent non-muscle-invasive bladder cancer was of a significantly lower histological grade with lower Ki-67-labeling indices than the initial muscle-invasive bladder cancer. Twelve (85.7%) of 14 patients with non-muscle-invasive bladder cancer recurrence achieved disease-free status. The multivariate analysis revealed that multiplicity, grade and tumor size were significantly correlated with the recurrence (P= 0.0001, 0.0442 and 0.0412, respectively). Most of the recurrences after bladder-preserving therapy were cases of non-muscle-invasive bladder cancer. The recurrence pattern and characteristics of the tumors did not differ from those of primary non-muscle-invasive bladder cancer. Patients with high-risk factors would be candidates for prophylactic intravesical therapy for non-muscle-invasive bladder cancer recurrence.

Citation

Mizuki Onozawa, Naoto Miyanaga, Shiro Hinotsu, Jun Miyazaki, Takehiro Oikawa, Tomokazu Kimura, Ei-Ichiro Takaoka, Koji Kawai, Toru Shimazui, Hideyuki Sakurai, Hiroyuki Nishiyama, Hideyuki Akaza. Analysis of Intravesical Recurrence After Bladder-preserving Therapy for Muscle-invasive Bladder Cancer. Japanese journal of clinical oncology. 2012 Sep;42(9):825-30