The natural history of non-muscle-invasive transitional cell carcinoma of the bladder

Summary 

Non-muscle-invasive (NMI) transitional cell carcinoma (TCC) of the bladder is a common disease that recurs frequently and may progress to more sinister invasive disease. In the absence of a molecular tool that can accurately predict an individual's propensity to tumour recurrence and/or progression, urologists utilise prognostic factors to predict patient outcome.

To ascertain the value and ranking of known prognostic factors we performed a MEDLINE search using the MeSH heading bladder neoplasm, with classification, epidemiology and mortality as subheadings. Papers describing significant cohorts of patients (>100) were identified and reviewed to ascertain tumour recurrence and progression rates, along with overall and bladder cancer-specific mortality. Factors affecting tumour recurrence, progression and survival were determined.

Tumour recurrence and progression rates varied between 46–70% and 6–56% respectively. Multifocality, previous high tumour recurrence rate, positive 3-month check cystoscopy and tumour size were predictive of tumour recurrence. Tumour grade, multifocality and tumour size were predictive of tumour progression. Overall and bladder cancer-specific survival varied between 8–85% and 56–99.4% respectively, and clearly related to duration of patient follow-up. Grade, stage and previous high tumour recurrence rates predicted patient survival.

The data obtained regarding prognostic factors are used to describe a rationale follow-up schedule for patients with NMI TCC of the bladder.

Keywords: Non-muscle-invasive TCC, Recurrence, Progression, Overall and disease-specific survival