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KMID : 0939920150470030495
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대한암학회지
2015 Volume.47 No. 3 p.495 ~ p.500
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Previous Bladder Cancer History in Patients with High-Risk, Non?muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History
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Lampros P. Mitrakas
Ioannis V. Zachos
Vassileios P. Tzortzis
Stavros A. Gravas
Erasmia C. Rouka
Konstantinos I. Dimitropoulos
Gerasimos P. Vandoros
Anastasios D. Karatzas
Michael D. Melekos
Athanasios G. Papavassiliou
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Abstract
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Purpose: The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non?muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette?Guerin (BCG) and to evaluate their natural history.
Materials and Methods: Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups.
Results: A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival.
Conclusion: Previous non?muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.
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KEYWORD
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High-risk, Non-muscle-invasive bladder cancer, Previous bladder cancer history, Recurrence, Disease progression
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