Early recurrence of non-muscle invasive bladder cancer as a clinical marker of a poor prognosis and cancer-specific survival

ObjectiveTo determine whether early recurrence of non-muscle invasive bladder cancer confers prognostic value with respect to bladder cancer-specific survival.Patients and methodsFollowing local ethics committee approval, all patients that underwent TURBT for a bladder tumour within the Oxford Radcliffe Trust between 1997 and 2007 were entered into the local Cancer Research Uro-Oncology Database (CRUD©). The rate of positive histological recurrence of non-muscle invasive bladder cancer at first cystoscopy (<4 months) following the index TURBT was calculated and the cancer-specific survival calculated using data from the National Cancer Intelligence Network.ResultsMedian positive early recurrence of (NMIBC) non-muscle invasive bladder cancer was 18.9% for the period of 1997 to 2007 (mean 20.3%; range 13.9–28.3%). Positive early recurrence was associated with significantly worse survival, with 5-year cancer specific survival falling from 82.3% (first cystoscopy negative) to 69.4%, (first cystoscopy positive), Log Rank p = 0.02.ConclusionsOur results suggest that if histological recurrence is present at first cystoscopy then the patient is more likely to die from bladder cancer, with 5-year cancer specific mortality of 18% if first cystoscopy clear, compared to 31% if histological recurrence (relative risk 1.7). With the growing demand for surgical outcome measures, our study suggests that ‘positive recurrence at first cystoscopy’ is both simple to measure and a valid predictor of patient outcome.