The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas, N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology,

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The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas, N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology, Sheffield Teaching Hospitals, Sheffield. Retrospective study of patients High risk NMIBC(G3Ta,G3T1,(G1,G2T1),CIS) Reported case series so far are of modest size and limited follow up Relationship between clinic pathologic features and outcome were analysed Primary outcomes- progression free, disease specific survival Secondary outcomes- radical cystectomy, recurrence free survival 951 Primary high-risk UCC Included: 712 high-risk UCC Excluded: 72 pT2 on re-resection 104 <6 months follow up 54 Second opinion 9 Non-UCC

T2 n=110 (15.8%) (3 yrs-18%) (5yrs-26.5%) Recurrence n=402 (56.5%) RC n=91(12.8%) DSM n=134 (18.8%) (3 yrs-17.2%) (5yrs-28.7%) 4.8months17.2months 28months 14.2months Included: 712 high-risk UCC P<0.001 T2 No-T2 Cancer specific survival Event free survival P<0.001 T2 No-T2 Follow up ( months) Ci s LG Dysplasia P<0.001 Event free survival P<0.001 Cis Normal LG Dysplasia Progression to muscle invasive disease P<0.665 No BCG BCG Event free survival Follow up ( months) Follow up ( months) Progression Age Dysplastic urotheliumDysplastic urothelium recurrence Death Age Stage Dyspalstic urotheliumDyspalstic urothelium

Conclusions Despite disparities in initial treatment (e.g. induction versus maintenance BCG versus chemotherapy), around 1 in 4 patients with high-risk NMI tumors progress to muscle invasion within 5 years of diagnosis. T2 progression increased DSM more than five fold when compared to non-progressing patients. Consequently, the long-term cure rate from radical treatment dropped from 90-91% to 48.6% with muscle invasion. BCG does not reduce progression in these tumors, suggesting a need to change in treatment strategy Our data enlarge the literature base and reveal consistency in outcomes that suggests a change in management for these tumors is required.

Cox regression analysis - progression Univariable Multivariable

Cox regression analysis - Death Univariable Multivariable

The long term outcome of high risk non-muscle invasive bladder cancer. F Thomas, N Rubin, J Goepel, D Rosario, MF Abbod, JWF Catto. Academic unit of Urology, Sheffield Teaching Hospitals, Sheffield.