The Evaluation of the Risk Factors for Non-Muscle Invasive Bladder Cancer (NMIBC) Recurrence after Transurethral Resection (TURBt) in Chinese Population

<div><p>Objective</p><p>The risk factors of bladder cancer recurrence after transurethral resection of bladder tumor (TURBt) were poorly understood, especially in Chinese population. This study evaluated the potential risk factors of recurrence based on a Chinese population.</p><p>Materials and Methods</p><p>A total of 698 patients that received TURBt procedure in our institute from 2000 to 2012 were recruited in this study. Clinical information was collected. The patients were followed up according to the schedule recommended by Chinese guideline.</p><p>Results</p><p>A total of 583 males (83.5%) and 115 females (16.5%) were enrolled in our study. The median follow-up duration was 51.5 months. Gender, chief complain, tumor size, number of lesions, histological grade and chemotherapeutic agents were found significantly associated with patients’ short-term recurrence (less than 1 year) (All p<0.05). In the multivariate analysis, tumor size, number of lesions, histological grade and chemotherapeutic agents were significantly related to patients’ short-term recurrence (less than 1 year) (All p<0.05). A multivariate model based on tumor size, number of lesions, histological grade and chemotherapeutic agents had an AUC of 0.697, which significantly improved the prediction utility for bladder cancer short-term recurrence (less than 1 year) than any single factor In the multivariate Cox regression, tumor size greater than 3 cm, multifocal lesions, worsen histological grade and non-urothelial carcinoma was related to time to recurrence (TR).</p><p>Conclusion</p><p>Patients with larger tumor size, multifocal number of lesions, higher tumor grade and who received chemotherapeutic agents other than Epirubicin and Pirarubicin might have higher risks of recurrence less than 1 year. Tumor size, number of lesions, pathology and histological grade might be associated with TR. As Bacille Calmette-Guerin (BCG) is currently not approved for bladder cancer in China, Epirubicin and Pirarubicin might be considered prior to other chemotherapy medications when providing post-operative instillation of chemotherapy.</p></div

Area under receiver operating curve.

<p>*The multi-variate model was built based on the variables of size, number of lesions, grade, chemotherapeutic agents.</p><p>^†P-values presented the differences between Multi-variate Model and other variables.</p><p>Area under receiver operating curve.</p

Receiver operating curve of short-term recurrence.

<p>Receiver operating curve of short-term recurrence includes clinical variables as size (AUC = 0.585), number of lesions(AUC = 0.615), grade(AUC = 0.613), chemotherapeutic agents(AUC = 0.544) and the multi-variate model(AUC = 0.697).</p

Clinical characteristics of all the patients and comparison of each variable between short-term and non-short-term recurrence group.

<p>* Size: the diameter of the largest lesion;</p><p>** Chemotherapeutic agents: the chemotherapy medications that were used in post-operative instillation</p><p>¹ The categorizations was the same as the 2013 EAU guideline</p><p>Clinical characteristics of all the patients and comparison of each variable between short-term and non-short-term recurrence group.</p