Early Recurrence Following Complete Initial Resection Predicts Adverse Oncological Outcomes in NMIBC

TL;DR

Bladder cancer patients who experience early tumor recurrence after initial surgery have worse outcomes, and factors like tumor size and treatment choices can predict this recurrence.

Contribution

Identifies early recurrence after complete bladder tumor resection as an independent predictor of poor outcomes in non-muscle-invasive bladder cancer.

Findings

Early recurrence occurred in 35.2% of patients and predicted worse progression-free and overall survival.

Tumor size, T1 stage, high-grade pathology, and lack of intravesical chemotherapy were independent predictors of early recurrence.

Adjuvant intravesical therapies reduced the risk of early recurrence.

Abstract

Background/Objectives: Early recurrence after complete initial transurethral resection of bladder tumor (TUR-BT) may indicate biologically aggressive non-muscle-invasive bladder cancer (NMIBC). This study aimed to identify clinicopathological predictors of ER and its independent impact on progression and survival outcomes. Methods: Clinical data of 335 primary NMIBC patients who underwent TUR-BT between 2012 and 2024 were retrospectively analyzed. Patients with non-primary tumors, incomplete resection, or follow-up <6 months were excluded from the study. Patients were categorized into recurrence-free, early recurrence, and late recurrence groups. Logistic regression was used to identify predictors of early recurrence. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox regression. A 36-month landmark analysis was conducted to adjust for heterogeneity in follow-up duration. Results: Early recurrence occurred in 118 patients (35.2%). Independent predictors of early recurrence were tumor size (OR = 1.012, p = 0.038), T1 stage (OR = 2.57, p = 0.004), high-grade pathology (OR = 1.933, p = 0.030), and absence of single-dose intravesical chemotherapy (IVC) (OR = 3.642, p = 0.025). Additionally, adjuvant IVC (OR = 0.279, p = 0.015) and intravesical BCG (OR = 0.427, p = 0.006) independently reduced the risk of early recurrence. Early recurrence independently predicted worse PFS (HR = 6.053), CSS (HR = 2.052), and OS (HR = 1.961) (all p < 0.001). The landmark analysis confirmed these results (all p < 0.05). Conclusions: Early recurrence after initial and complete TUR-BT is an independent predictor of adverse oncological outcomes. Identifying high-risk patients and applying early intravesical therapy may improve outcomes by preventing early recurrence.

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