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The long term outcome of high risk non-muscle invasive bladder cancer.

The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas , N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology, Sheffield Teaching Hospitals, Sheffield. Retrospective study of patients 1994-2009 High risk NMIBC(G3Ta,G3T1,(G1,G2T1),CIS)

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The long term outcome of high risk non-muscle invasive bladder cancer.

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  1. The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas, N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology, Sheffield Teaching Hospitals, Sheffield. • Retrospective study of patients • 1994-2009 • High risk NMIBC(G3Ta,G3T1,(G1,G2T1),CIS) • Reported case series so far are of modest size and limited follow up • Relationship between clinic pathologic features and outcome were analysed • Primary outcomes- progression free, disease specific survival • Secondary outcomes- radical cystectomy, recurrence free survival Excluded: 72 pT2 on re-resection 104 <6 months follow up 54 Second opinion 9 Non-UCC 951 Primary high-risk UCC Included: 712 high-risk UCC

  2. Cancer specific survival Event free survival • Death • Age • Stage • Dyspalstic urothelium No-T2 No-T2 Progression to muscle invasive disease No BCG BCG T2 T2 P<0.001 P<0.001 Follow up ( months) P<0.665 • Progression • Age • Dysplastic urothelium • recurrence 1 1 1 0.8 0.8 0.8 0.6 0.6 0.6 0.4 0.4 0.4 48 48 48 0 0 0 24 24 24 72 72 72 168 168 168 192 192 192 96 96 96 120 120 120 144 144 144 0.2 0.2 0.2 0.0 0.0 0.0 Follow up ( months) Included: 712 high-risk UCC 28months 4.8months 17.2months 14.2months T2 n=110 (15.8%) (3 yrs-18%) (5yrs-26.5%) Recurrence n=402 (56.5%) DSM n=134 (18.8%) (3 yrs-17.2%) (5yrs-28.7%) RC n=91(12.8%) Progression to muscle invasive disease Event free survival Normal Cis Cis LG Dysplasia LG Dysplasia Follow up ( months) P<0.001 P<0.001 Event free survival

  3. Conclusions • Despite disparities in initial treatment (e.g. induction versus maintenance BCG versus chemotherapy), around 1 in 4 patients with high-risk NMI tumors progress to muscle invasion within 5 years of diagnosis. • T2 progression increased DSM more than five fold when compared to non-progressing patients. • Consequently, the long-term cure rate from radical treatment dropped from 90-91% to 48.6% with muscle invasion. • BCG does not reduce progression in these tumors, suggesting a need to change in treatment strategy • Our data enlarge the literature base and reveal consistency in outcomes that suggests a change in management for these tumors is required.

  4. Cox regression analysis - progression Multivariable Univariable

  5. Cox regression analysis - Death Multivariable Univariable

  6. The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas, N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology, Sheffield Teaching Hospitals, Sheffield.

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