Bladder Cancer Coverage from Every Angle

Predicting Risk of Recurrence in Nonmuscle‐Invasive Bladder Cancer

By: Hillary Ojeda
Posted: Monday, January 4, 2021

According to a multisite, community-based study, conducted by Matthew E. Nielsen, MD, MS, of Kaiser Permanente Northwest, Portland, Oregon, and colleagues, the predicted risk of high-risk recurrences and disease progression seems to increase depending on the initial tumor classification and grade at diagnosis of nonmuscle-invasive bladder cancer. The study results, which were published in the journal Cancer, may help improve risk-stratified treatment, the authors proposed.

“What is novel about our findings are the tables that clinicians and patients may use when discussing options for long-term management and risk-aligned surveillance schedules, in particular for the large segment of patients with lower-risk disease,” the authors concluded.

A total of 2,956 patients with nonmuscle-invasive bladder cancer were identified from Kaiser Permanente Northwest and Geisinger. They had been diagnosed between 1994 and 2015. The authors collected reports for all cases of disease progression and recurrence after initial diagnosis and noted tumor classification, grade, tumor size, and number of tumors. Based on the tumor classification and grade of the recurrence, they established four risk-stratified outcomes: any recurrence; intermediate‐risk recurrence (Ta high grade, carcinoma in situ, T1 low grade) or higher; high‐risk recurrence (T1 high grade) or disease progression (clinical T2); and disease progression. Via multivariable Cox proportional hazards regression, 1-year and 5-year risk estimates were determined for each outcome.

There were 1,062 recurrences and 111 cases of disease progression, after a median follow-up of 29.4 months. The predicted risk of high-risk recurrence and disease progression increased with higher tumor classification and grade at initial diagnosis. The adjusted hazard ratio was 2.60 for Ta high-grade tumors, 4.74 for tumor in situ, and 7.14 for T1 high-grade tumors. “Using Ta high‐grade tumors as an example, the 1‐year and 5‐year predicted rates of adjusted risk of a high‐risk recurrence or progression were 4.4% and 7.9%, respectively,” the study authors reported.

Disclosure: The study authors’ disclosure information can be found at

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