Recurrence of high-risk bladder cancer: a population-based analysis.
BACKGROUND
Patients with bladder cancer are apt to develop multiple recurrences that require intervention. The recurrence, progression, and bladder cancer-related mortality rates were examined in a cohort of individuals with high-grade non-muscle-invasive bladder cancer.


METHODS
Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, subjects were identified who had a diagnosis of high-grade, non-muscle-invasive disease in 1992 to 2002 and who were followed until 2007. Multivariate competing-risks regression analyses were then used to examine recurrence, progression, and bladder cancer-related mortality rates.


RESULTS
Of 7410 subjects, 2897 (39.1%) experienced a recurrence without progression, 2449 (33.0%) experienced disease progression, of whom 981 succumbed to bladder cancer. Using competing-risks regression analysis, the 10-year recurrence, progression, and bladder cancer-related mortality rates were found to be 74.3%, 33.3%, and 12.3%, respectively. Stage T1 was the only variable associated with a higher rate of recurrence. Women, black race, undifferentiated grade, and stage Tis and T1 were associated with a higher risk of progression and mortality. Advanced age (≥ 70) was associated with a higher risk of bladder cancer-related mortality.


CONCLUSIONS
Nearly three-fourths of patients diagnosed with high-risk bladder cancer will recur, progress, or die within 10 years of their diagnosis. Even though most patients do not die of bladder cancer, the vast majority endures the morbidity of recurrence and progression of their cancer. Increasing efforts should be made to offer patients intravesical therapy with the goal of minimizing the incidence of recurrences. Furthermore, the high recurrence rate seen during the first 2 years of diagnosis warrants an intense surveillance schedule.
['Chamie|Karim|K|', 'Litwin|Mark S|MS|', 'Bassett|Jeffrey C|JC|', 'Daskivich|Timothy J|TJ|', 'Lai|Julie|J|', 'Hanley|Jan M|JM|', 'Konety|Badrinath R|BR|', 'Saigal|Christopher S|CS|', '|||']
D000368:Aged D000369:Aged, 80 and over D018450:Disease Progression D005260:Female D006801:Humans D015994:Incidence D008297:Male D009017:Morbidity D015999:Multivariate Analysis D060787:Neoplasm Grading D009364:Neoplasm Recurrence, Local D009367:Neoplasm Staging D016017:Odds Ratio D012307:Risk Factors D018426:SEER Program D012737:Sex Factors D015996:Survival Rate D013997:Time Factors D014481:United States D001749:Urinary Bladder Neoplasms
recurrence progression bladder cancer mortality quality of healthcare urinary bladder neoplasms