Contemporary outcomes in non‐muscle‐invasive bladder cancer: a large European multicentre study
Mattia Longoni, Pietro Scilipoti, Mario de Angelis, Paolo Zaurito, Gemma Tremolada, Alfonso Santangelo, Giuseppe Simone, Riccardo Mastroianni, Chiara Lonati, Stefania Zamboni, Nazareno Suardi, Gautier Marcq, Aleksandra Szostek, J. Caño Velasco, A. Lafuente Puentedura, José Daniel Subiela, P. Del Olmo Duran, Aleksander Ślusarczyk, Pierre I. Karakiewicz, Benjamin Pradere, Francesco Soria, Paolo Gontero, Morgan Rouprêt, Francesco Montorsi, Andrea Salonia, Alberto Briganti, Marco Moschini
Abstract
OBJECTIVE: To report real-world rates of non-muscle-invasive bladder cancer (NMIBC) recurrence and progression within a European multicentre cohort with detailed information on intravesical instillation courses, as contemporary data on oncological outcomes in NMIBC are limited. PATIENTS AND METHODS: A total of 1918 patients with NMIBC treated with transurethral resection of bladder tumour (TURBT) were retrospectively identified from six tertiary-referral European centres (2015-2022). Patients were stratified according to European Association of Urology 2021 criteria into low- (LR), intermediate- (IR), high- (HR) and very high-risk (VHR) categories. Cumulative incidence plots and multivariable competing risks regression models addressing 5-year rates of high-grade (HG) recurrence and progression were fitted. Sensitivity analyses focused on patients receiving intravesical instillations and tested for the effect of adequate course (Bacillus Calmette-Guérin: five or more induction + two or more maintenance instillations; mitomycin C: complete induction + ≥11 maintenance instillations). RESULTS: Of all NMIBC patients identified, 467 (24.3%) were LR vs 582 (30.3%) IR vs 739 (38.5%) HR vs 130 (6.8%) VHR. The median (interquartile range) follow-up after TURBT was 26 (12-46) months. The 5-year HG recurrence rates were 7.2% in LR vs 17.3% in IR vs 26.7% in HR vs 30.9% in VHR patients, resulting in a three-, five- and seven-fold higher risk of IR, HR and VHR, respectively, relative to LR (all P < 0.001). The 5-year progression rates were 3.9% in LR vs 5.2% in IR vs 13.6% in HR vs 31.6% in VHR patients, resulting in a six- and nine-fold higher risk for HR and VHR, respectively, relative to LR (all P < 0.001). In all, 1001 (52.2%) patients underwent intravesical instillations. Those receiving adequate instillation course (244/1001 [24.3%]) had lower HG-recurrence (hazard ratio 0.3, P < 0.001) and progression (hazard ratio 0.2, P = 0.001) risk. CONCLUSIONS: Patients with HR/VHR NMIBC face significantly higher HG recurrence and progression risks. While tailored treatment strategies are needed, adherence to adequate instillation course remains crucial for optimising oncological outcomes.