Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective

Nat Rev Urol. 2022 May;19(5):280-294. doi: 10.1038/s41585-022-00578-1. Epub 2022 Mar 31.


Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15-61%, and a 5-year recurrence rate of 31-78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.

Publication types

  • Review

MeSH terms

  • Carcinoma, Transitional Cell* / pathology
  • Carcinoma, Transitional Cell* / surgery
  • Cystectomy / methods
  • Female
  • Humans
  • Male
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / surgery
  • Urinary Bladder Neoplasms* / diagnosis
  • Urinary Bladder Neoplasms* / surgery