Late recurrence and progression after a long tumor-free period in primary Ta and T1 bladder cancer

Eur Urol. 1999 Oct;36(4):309-13. doi: 10.1159/000020010.


Objective: To determine the probability and risk factors of recurrence and progression (to T2 or worse) after a long tumor-free period in patients with superficial (stage Ta and T1) bladder cancer.

Patients and methods: A consecutive series of 100 patients with superficial bladder cancer who remained tumor-free for longer than 4 years after initial treatment were reviewed. The rates of recurrence and progression were statistically assessed and the significance of risk factors was determined.

Results: Of the 100 patients, 24 (24. 0%) recurred within 15 years after the initial treatment. The 10- and 15-year recurrence-free rates were 76.0 and 59.6%, respectively. Among the clinicopathological variables examined, intravesical chemotherapy was determined by a log-rank test to be a significant unfavorable risk factor for late recurrence (p < 0.001). Progression of the tumor occurred in 5 patients. Four variables including presence of multiple tumors, involvement of the bladder neck, positive urine cytology, and intravesical chemotherapy were found by a univariate analysis to be significant risk factors for late progression (p < 0.05). Among these factors, initial presence of multiple tumors (3 or more) was determined by a multivariate analysis to be an independent risk factor for late progression.

Conclusion: Recurrence and progression continue to occur in patients with superficial bladder cancer even after long periods of dormancy. Regular follow-up urological assessments should be continued until at least 15 years of tumor-free existence, especially in patients treated by intravesical chemotherapy or those initially having multiple tumors.

MeSH terms

  • Administration, Intravesical
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Transitional Cell / diagnosis
  • Carcinoma, Transitional Cell / drug therapy
  • Carcinoma, Transitional Cell / epidemiology*
  • Carcinoma, Transitional Cell / mortality
  • Disease Progression
  • Disease-Free Survival
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Staging
  • Neoplasms, Second Primary / diagnosis
  • Neoplasms, Second Primary / drug therapy
  • Neoplasms, Second Primary / epidemiology*
  • Neoplasms, Second Primary / mortality
  • Risk Factors
  • Smoking
  • Survival Rate
  • Time
  • Urinary Bladder Neoplasms / diagnosis
  • Urinary Bladder Neoplasms / drug therapy
  • Urinary Bladder Neoplasms / epidemiology*
  • Urinary Bladder Neoplasms / mortality