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
. 2023 Jan 21;15(3):668.
doi: 10.3390/cancers15030668.

Incidental Diagnosis of Urothelial Bladder Cancer: Associations with Overall Survival

Hubert Kamecki  1   2 , Małgorzata Dębowska  3   4 , Jan Poleszczuk  4 , Tomasz Demkow  1 , Artur Przewor  1 , Łukasz Nyk  2 , Roman Sosnowski  1
Affiliations

Incidental Diagnosis of Urothelial Bladder Cancer: Associations with Overall Survival

Hubert Kamecki et al. Cancers (Basel). .

Abstract

Background: We investigated whether an incidental diagnosis (ID) of bladder cancer (BC) was associated with improved survival.

Methods: We retrospectively reviewed data of consecutive patients with no prior diagnosis of urothelial cancer who underwent a primary transurethral resection of bladder tumor (pTURBT) between January 2013 and February 2021 and were subsequently diagnosed with urothelial BC. The type of diagnosis (incidental or non-incidental) was identified. Overall, relative, recurrence-free, and progression-free survival rates (OS, RS, RFS, and PFS) after pTURBT were evaluated using the Kaplan-Meier curves and long-rank tests. A multivariable Cox regression model for the overall mortality was developed.

Results: A total of 435 patients were enrolled. The median follow-up was 2.7 years. ID cases were more likely to be low-grade (LG) and non-muscle-invasive. ID vs. non-ID was associated with a trend toward an improved 7-year OS (66% vs. 49%, p = 0.092) and a significantly improved 7-year OS, if incidental cases were limited to ultrasound-detected tumors (75% vs. 49%, p = 0.013). ID was associated with improved survival among muscle-invasive BC (MIBC) patients (3-year RS: 97% vs. 23%, p < 0.001), but not among other subgroups stratified according to disease stage or grade. In multivariable analysis, only age, MIBC, and high-grade (HG) cancer demonstrated an association with mortality. PFS and RFS among non-MIBC patients did not differ in regard to the type of diagnosis.

Conclusions: Incidental diagnosis may contribute to an improved survival in BC patients, most probably in the mechanism of the relative downgrading of the disease, including the possible overdiagnosis of LG tumors. Nevertheless, in the subgroup analyses, we noted marked survival benefits in MIBC cases. Further prospective studies are warranted to gain a deeper understanding of the observed associations.

Keywords: bladder cancer; incidental diagnosis; screening; survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) 7-year overall survival (OS), stratified according to type of diagnosis (incidental vs. non-incidental); (B) 7-year relative survival (RS); (C) 2-year OS; and (D) 2-year RS.
Figure 2
Figure 2
(A) 7-year overall survival (OS), stratified according to type of diagnosis: incidental diagnosis performed with ultrasound vs. non-incidental diagnosis; and (B) 7-year relative survival (RS).
Figure 3
Figure 3
(A) 7-year overall survival (OS) stratified according to cancer grade (low-grade (LG) vs. high-grade (HG)); (B) 7-year relative survival (RS) stratified according to cancer grade; (C) 7-year OS in non-metastatic HG patients stratified according to disease stage (non-muscle-invasive bladder cancer (NMIBC) vs. muscle-invasive-bladder cancer (MIBC)); and (D) 7-year RS according to disease stage.
Figure 4
Figure 4
(A) 7-year overall survival (OS) in high-grade (HG) patients stratified by type of diagnosis (incidental vs. non-incidental); and (B) 7-year RS.
Figure 5
Figure 5
(A) 7-year overall survival (OS) in non-metastatic high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) patients stratified by type of diagnosis (incidental vs. non-incidental); (B) 7-year relative survival (RS); (C) 3-year OS in non-metastatic MIBC patients stratified by type of diagnosis; and (D) 7-year RS.
Figure 6
Figure 6
(A) 3-year recurrence-free survival (RFS) in non-muscle-invasive bladder cancer (NMIBC) patients stratified by type of diagnosis (incidental vs. non-incidental); and (B) 3-year progression-free survival (PFS).
See this image and copyright information in PMC

References

    1. Safiri S., Kolahi A.-A., Naghavi M. Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease study 2019. BMJ Glob. Health. 2021;6:e004128. doi: 10.1136/bmjgh-2020-004128. - DOI - PMC - PubMed
    1. Cambier S., Sylvester R.J., Collette L., Gontero P., Brausi M.A., van Andel G., Kirkels W.J., Da Silva F.C., Oosterlinck W., Prescott S., et al. EORTC Nomograms and Risk Groups for Predicting Recurrence, Progression, and Disease-specific and Overall Survival in Non–Muscle-invasive Stage Ta–T1 Urothelial Bladder Cancer Patients Treated with 1–3 Years of Maintenance Bacillus Calmette-Guérin. Eur. Urol. 2016;69:60–69. doi: 10.1016/j.eururo.2015.06.045. - DOI - PubMed
    1. International Collaboration of Trialists. Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group) European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group. Australian Bladder Cancer Study Group. National Cancer Institute of Canada Clinical Trials Group. Finnbladder. Norwegian Bladder Cancer Study Group. Club Urologico Espanol de Tratamiento Oncologico Group. Griffiths G., Hall R., et al. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: Long-term results of the BA06 30894 trial. J. Clin. Oncol. 2011;29:2171–2177. - PMC - PubMed
    1. Lei A.Q., Cheng L., Pan C.-X. Current treatment of metastatic bladder cancer and future directions. Expert Rev. Anticancer. Ther. 2011;11:1851–1862. doi: 10.1586/era.11.181. - DOI - PubMed
    1. Larré S., Catto J.W., Cookson M.S., Messing E.M., Shariat S.F., Soloway M.S., Svatek R.S., Lotan Y., Zlotta A.R., Grossman H.B. Screening for Bladder Cancer: Rationale, Limitations, Whom to Target, and Perspectives. Eur. Urol. 2013;63:1049–1058. doi: 10.1016/j.eururo.2012.12.062. - DOI - PubMed

LinkOut - more resources