Low-intensity cystoscopic surveillance may be a viable option for patients with high-risk, non-muscle invasive bladder cancer (NMIBC), according to a new abstract from researchers in New Hampshire. This abstract will be presented to the media during a special session moderated by AUA Public Media Chair Sam Chang on May 15 at 8:30 a.m.
In this retrospective cohort study of 1,542 veterans diagnosed with high-risk NMIBC between 2005 and 2011 with follow up care through 2014, researchers at Dartmouth-Hitchcock reviewed the association of low-intensity surveillance cystoscopies (one to five procedures) vs. high-intensity cystoscopies (six or more procedures) with frequency of transurethral resections, as well as risk of progression and bladder cancer death in patients.
Patients who underwent low-intensity surveillance (520, or 33.7 percent) were found to have fewer transurethral resections than those with high-intensity surveillance (37 vs. 99 per 100 person-years). Stage of disease (non-invasive vs. invasive) was not found to be a confounding factor; no statistical difference was found between frequency or cystoscopic surveillance and risk of bladder cancer progression or death. Patients undergoing low-intensity surveillance had a decreased risk of progression to invasive disease or death compared to the high-intensity group (19.3 percent vs. 31.4 percent at five years). Similarly, of the patients with non-invasive disease who underwent fewer cystoscopies. 5.7 percent had an increased risk of death at five years compared to 8.2 percent of patients with more aggressive surveillance protocols.
“The authors should be commended for their efforts to determine the most appropriate surveillance schedule for patients with non-muscle invasive bladder cancer. The findings are provocative, but every retrospective study is affected by selection bias,” Dr. Chang said. “I want to caution, as the authors themselves conclude, that their findings serve to justify a future clinical trial and should NOT guide current clinical practice.”
The Impact of Low- versus High-Intensity Surveillance Cystoscopy on Surgical Care and Cancer Outcomes in Patients with High-Risk Non-Muscle-Invasive Bladder Cancer (NMIBC)
Michael Rezaee, Kristine Lynch, Zhongze Li, Todd MacKenzie, John Seigne, Douglas Robertson, Brenda Sirovich, Philip Goodney, Florian Schroeck
Introduction: Surveillance guidelines for NMIBC are based on expert opinion and informed by limited evidence. To assess the association of low- vs. guideline-recommended high-intensity cystoscopic surveillance with outcomes among patients with high-risk non-muscle invasive bladder cancer (NMIBC).
Methods: A retrospective cohort study of Veterans Affairs patients diagnosed with high-risk NMIBC between 2005 and 2011 with follow-up through 2014. Patients were categorized by number of surveillance cystoscopies over two years following diagnosis: low- (1-5) vs. high-intensity (6 or more) surveillance. Propensity score adjusted regression models were used to assess the association of low-intensity cystoscopic surveillance with frequency of transurethral resections, and risk of progression to invasive disease and bladder cancer death.
Results: Among 1,542 patients, 520 (33.7%) underwent low-intensity cystoscopic surveillance. Patients undergoing low-intensity surveillance had fewer transurethral resections (37 vs. 99 per 100 person-years; p<0.001). Low vs. high-intensity surveillance was not associated with risk of bladder cancer death among patients with non-invasive (cumulative incidence [CIn] 5.7% vs. 8.2% at 5 years, p=0.25) or with invasive disease at diagnosis (CIn 10.1% vs. 9.7% at 5 years, p=0.81). Among a subset of patients with non-invasive disease, low-intensity surveillance was associated with decreased risk of progression to invasive disease or bladder cancer death (CIn 19.3% vs. 31.4% at 5 years, p=0.002).
Conclusions: Patients with high-risk NMIBC undergoing low- vs. high-intensity cystoscopic surveillance underwent fewer transurethral resections, but did not experience an increased risk of progression or bladder cancer death. These findings provide a strong rationale for a clinical trial to determine whether low-intensity surveillance is comparable to high-intensity surveillance for cancer control in high-risk NMIBC.
Funding Source: None