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Linton KD, Thomas F, Rubin N, Rosario DJ, Catto JW Sheffield Teaching Hospitals

Muscle invasion and disease specific mortality in patients with low risk bladder cancer: Time to change follow up?. Linton KD, Thomas F, Rubin N, Rosario DJ, Catto JW Sheffield Teaching Hospitals. Introduction. Low grade bladder cancer accounts for 30% of bladder cancers at diagnosis.

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Linton KD, Thomas F, Rubin N, Rosario DJ, Catto JW Sheffield Teaching Hospitals

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  1. Muscle invasion and disease specific mortality in patients with low risk bladder cancer: Time to change follow up? Linton KD, Thomas F, Rubin N, Rosario DJ, Catto JW Sheffield Teaching Hospitals

  2. Introduction • Low grade bladder cancer accounts for 30% of bladder cancers at diagnosis. • Progression to muscle invasion or metastases is rare. • Superficial bladder cancer is one of the most expensive malignancies to treat. • We hypothesized that patients with initial G1pTa bladder cancer would have a similar disease specific mortality to their age and gender matched populations. • If this is correct it could have consequences for clinical follow up

  3. Patients and Methods • All G1pTa 1994 to Dec 2009 • Pharmacy, hospital episode, histopathology and cancer registry records checked • Notes reviewed of all progressions to T2 or death from bladder cancer • National and regional DSM calculated • Inclusion criteria : • Primary G1pTa • No adverse features • No CIS • No other malignancy • Follow up of at least one cystoscopy 3,633 primary TCC bladder 699 (19%) primary G1pTa 33 progress to high grade NMIBC 4 died from metastatic TCC 14 progress to MIBC 5 died from metastatic TCC 6 radical cystectomy 3 radical radiotherapy 8 died from metastatic TCC 1 disease free post cystectomy

  4. Results • 699 (19%) patients – 67.8% male • Mean age 69.4 years • Median follow up 61 months • 50% minimum follow up 5 years • Overall recurrence 28.5% • 3% at three months • 7.8% at twelve months • tumour weight was the only pathological parameter associated with recurrence

  5. Progression 699 primary G1pTa 33 (4.7%) progress to high grade NMIBC Median time 35.7 months 9 annual cystoscopy Median time 75 months 14 (2%) progress to MIBC 5 symptoms 1-15 cystoscopies needed to detect each progression Recurrence was associated with progression on multivariate analysis Low grade dysplasia and tumour weight associated with DSM DSM 5x regional and 6x national rates

  6. Progression - 3 patterns of disease progression • Misclassification – median progression 12.4 months • Early progression – (gradual upstaging) median progression 59.3 months • Delayed progression – (long dormant period) median progression 98 months Follow up months

  7. Costs to the NHS - Recurrence £4809 per recurrence Grade progression £100,989 per event £257,625 per event Stageprogression

  8. Conclusions • This cohort has a 5x risk of BCSM compared to the background population • Current follow up regimes have failed to alter the natural history in all but one patient • Alternative strategies are needed, ?regular cytology, ?urinary biomarkers, ?better patient education

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