Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 31:13:2937-2945.
doi: 10.2147/CMAR.S299148. eCollection 2021.

The Impact of Non-Compliance to a Standardized Risk-Adjusted Protocol on Recurrence, Progression, and Mortality in Non-Muscle Invasive Bladder Cancer

Faris Abushamma  1   2   3 , Zain Khayyat  1 , Aya Soroghle  1 , Sa'ed H Zyoud  4   5 , Ahmad Jaradat  1   2 , Maha Akkawi  1   6 , Hanood Aburass  1   6 , Iyad K K Qaddumi  7 , Razan Odeh  8 , Husam Salameh  8 , Salah Albuheissi  3
Affiliations

The Impact of Non-Compliance to a Standardized Risk-Adjusted Protocol on Recurrence, Progression, and Mortality in Non-Muscle Invasive Bladder Cancer

Faris Abushamma et al. Cancer Manag Res. .

Abstract

Purpose: Non-muscle invasive bladder cancer (NMIBC) is a potentially curable or controllable disease if strict adherence to a surveillance protocol is followed. Management and surveillance of NMIBC begins at the time of diagnosis up to a few years thereafter. There is scanty data in the literature evaluating the impact of non-compliance with the surveillance protocols on progression, recurrence, and mortality rate.

Patients and methods: An observational, retrospective cohort study recruited data between 2012 and 2017 at two tertiary hospitals. Data were collected consecutively. NMIBC patients who had at least 3 years of follow-up data were included. Patients were divided into different groups based on their compliance with the cystoscopy follow-up protocol as recommended by the European guidelines. We compared the cystoscopy compliant group with the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance were calculated using a new scoring model to predict adverse outcomes.

Results: Eighty-eight NMIBC patients met our criteria. Recurrence rate (RR), progression rate (PR), metastasis rate (MsR), and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (P<0.001), PR: (54.1%) (P<0.001), MsR: (37.7%) (P<0.001), MR: (23.5%) (P= 0.002) respectively. In the subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group, while it is 100% (P<0.001) and 56.4% (P=0.001) in the non-compliant group, respectively. Use of a Kaplan Meier (KM) graph shows that compliant patients had a better survival in comparison to non-compliant patients. Scoring there or more is statistically and clinically significantly associated with higher recurrence, progression, and mortality. RR: (94%) (P=0.016), PR: 49% (P<0.001) and MR (26%) (P=0.012).

Conclusion: Non-compliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group. This mandates strict adherence to surveillance guidelines particularly in patients with high-risk disease.

Keywords: COVID-19; NMIBC; haematuria; urological malignancies.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest for this work.

Figures

Figure 1
Figure 1
Comparison of the estimated probability of mortality among compliant versus non-compliant patients in the follow-up of NMIBC based on the Kaplan–Meier method for 5 years post-diagnosis.
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–386. doi: 10.1002/ijc.29210 - DOI - PubMed
    1. Larsson SC, Andersson SO, Johansson JE, Wolk A. Diabetes mellitus, body size and bladder cancer risk in a prospective study of Swedish men. Eur J Cancer. 2008;44(17):2655–2660. doi: 10.1016/j.ejca.2008.07.012 - DOI - PubMed
    1. Comperat E, Larre S, Roupret M, et al. Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch. 2015;466(5):589–594. doi: 10.1007/s00428-015-1739-2 - DOI - PubMed
    1. Babjuk M, Bohle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol. 2017;71(3):447–461. doi: 10.1016/j.eururo.2016.05.041 - DOI - PubMed
    1. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466. doi: 10.1016/j.eururo.2005.12.031 - DOI - PubMed