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Low‐risk non‐muscle‐invasive bladder cancer: Further prognostic stratification into the “very‐low‐risk” group based on tumor size
Author(s) -
Lee Alvin,
Lee Han Jie,
Huang Hong Hong,
Ho Henry,
Chen Kenneth
Publication year - 2019
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.13913
Subject(s) - medicine , bladder cancer , interquartile range , proportional hazards model , cohort , cancer , multivariate analysis , risk stratification , urology , log rank test , gastroenterology , oncology
Objective To validate the significance of the entity of “very‐low‐risk” bladder cancer by analyzing the clinical outcomes of low‐risk bladder cancer when further stratified by tumor size. Methods We accessed our prospectively maintained, single‐institution, electronic bladder cancer registry to extract the clinicopathological data of patients who were diagnosed with primary, solitary, Ta, low‐grade tumors that were <3 cm. Patients were divided into two prognostic groups based on tumor size (≤1.0 cm vs >1.0 cm). The survival data of the two groups were compared for recurrence, progression and mortality. Results A total of 165 patients were followed up for a median period of 79 months (interquartile range 47–118 months). A total of 45% (75/165) of the study cohort had tumors that were ≤1.0 cm. Recurrences were found in 40% (66/165) of the study cohort. On Kaplan–Meier analysis, patients with tumor size ≤1.0 cm had significantly longer time to recurrence ( P < 0.001, log–rank test). Using multivariate Cox modeling, only tumor size >1.0 cm was significantly associated with shorter time to recurrence ( HR 2.54, 95% CI 1.35–4.77, P = 0.004). Tumor size was not significantly associated with any differences in time to overall progression, muscle‐invasive progression or overall mortality ( P = 0.108, P = 0.362 and P = 0.225, respectively, log–rank test). Conclusions Low‐risk bladder cancer can be further stratified based on tumor size. Larger tumors (>1.0 cm) are significantly associated with shorter time to recurrence compared with smaller tumors (≤1.0 cm). However, there were no significant differences in the probability of developing disease progression or overall mortality between larger and smaller tumors.