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Thomas Flaig, MD


Effects of Multiple Risk Factors on Cancer-Specific Survival in Non–Muscle-Invasive Bladder Cancer

By: Chris Schimpf, BS
Posted: Wednesday, August 23, 2023

Considering the significant variation in tumor types and prognoses among patients with non–muscle-invasive bladder cancer, Aleksander Ślusarczyk, MD, of the Medical University of Warsaw, and colleagues conducted a population-based study designed to report real-world, cancer-specific survival of the disease across tumor types and risk factors. Their findings, published in Annals of Surgical Oncology, suggest that high-grade tumors invading the submucosa are associated with the highest risk of long-term cancer-specific mortality. In addition, relatively rarely diagnosed high-grade noninvasive papillary tumors and low-grade tumors invading the submucosa should also be considered high-risk disease.

Among the risk factors, the investigators reported that tumor stage, grade, and patient age appear to be the most powerful determinants of cancer-specific survival, but other sociodemographic factors might also affect the prognosis. To further illustrate their findings, the team developed a prognostic nomogram for predicting cancer-specific survival in non–muscle-invasive bladder cancer including the following risk factors: tumor T category and grade, patient age, tumor size and location, histology type, primary character, patient race, income, and marital status.

A total of 98,238 patients with non–muscle-invasive bladder cancer were included in the study, drawn from the SEER (Surveillance, Epidemiology, and End Results) database. Participants were diagnosed between 2004 and 2015 and subsequently underwent transurethral resection of a bladder tumor.

At the median follow-up of 124 months (interquartile range = 81–157 months), the investigators observed that cancer-specific mortality was highest for high-grade tumors invading the submucosa (19.52%), followed by carcinoma in situ (15.56%), which was similar to low-grade tumors invading the submucosa and high-grade noninvasive papillary tumors (10.9% and 9.2%, respectively). The lowest cancer-specific mortality was reported for low-grade noninvasive papillary tumors (3.76%). The team then used multivariable Cox regression to develop their prognostic nomogram.

Disclosure: The study authors reported no conflicts of interest.

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