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. 2023 Nov;30(12):7892-7902.
doi: 10.1245/s10434-023-14051-9. Epub 2023 Aug 14.

Cancer-Specific Survival of Patients with Non-Muscle-Invasive Bladder Cancer: A Population-Based Analysis

Aleksander Ślusarczyk  1 , Piotr Zapała  2 , Łukasz Zapała  2 , Tomasz Borkowski  2 , Piotr Radziszewski  2
Affiliations

Cancer-Specific Survival of Patients with Non-Muscle-Invasive Bladder Cancer: A Population-Based Analysis

Aleksander Ślusarczyk et al. Ann Surg Oncol. 2023 Nov.

Abstract

Background and purpose: Non-muscle-invasive bladder cancer (NMIBC) constitutes a heterogeneous group of tumors with different prognoses. This population-based study aimed to report real-world cancer-specific survival (CSS) of NMIBC and create a prognostic nomogram based on the identified risk factors.

Methods: The Surveillance, Epidemiology, and End Results database was searched for patients diagnosed with NMIBC from 2004 to 2015, who underwent transurethral resection of the bladder tumor. The dataset was divided into development and validation cohorts. Factors associated with CSS were identified using Cox proportional hazards and used to develop a prognostic nomogram.

Results: In total, 98,238 patients with NMIBC were included. At the median follow-up of 124 months (IQR 81-157 months), cancer-specific mortality (CSM) was highest for T1HG (19.52%), followed by Tis (15.56%), similar for T1LG and TaHG (10.88% and 9.23%, respectively), and lowest for TaLG (3.76%). Multivariable Cox regression for CSS prediction was utilized to develop a nomogram including the following risk factors: tumor T category and grade, age, tumor size and location, histology type, primary character, race, income, and marital status. In the validation cohort, the model was characterized by an AUC of 0.824 and C-index that reached 0.795.

Conclusions: To conclude, NMIBC is associated with a significant risk of long-term CSM especially, but not only, in patients with T1HG. Rarely diagnosed TaHG and T1LG tumors should be regarded as high-risk due to approximately 10% CSM. T category, grading, and age remain the most powerful determinants of CSS in NMIBC, but sociodemographic factors might also influence its prognosis.

Keywords: Age; Cancer-specific survival; Nomogram; Non-muscle-invasive bladder cancer; Stage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The association between the tumour stage (A), grade (B), location (C), histology (D), size (E), primary character (F), and cancer-specific survival of NMIBC patients. Legend: location (1- lateral/ posterior/ trigone; 2- anterior/dome; 3- neck; 4- more than one area; 5- not specified/multiple); histology (1- urothelial/2- squamous/3- other types).
Fig. 2.
Fig. 2.
The association between age (A), gender (B), race (C), marital status (D), and cancer-specific survival of NMIBC patients. The association between tumour stage with overall survival (E), and other-cause mortality (F). Legend: age (1- < 60 yr; 2- 60-70 yr; 3- 70-80 yr; 4- >80 years); male (no/yes); race (1-White /2- Black/3- other); 3- married (0- no/1- yes/2- unknown).
Fig. 3
Fig. 3
Prognostic nomogram for cancer-specific survival in non-muscle-invasive bladder cancer. Legend: Age groups (years), Bladder tumor location: 1- trigone or posterior or lateral walls; 2- anterior wall or dome; 3- bladder neck; 4- tumor in overlapping sites; 5- non-otherwise specified location, including multiple tumors.
Fig. 4
Fig. 4
Time-dependent area under the curve (AUC) (A), and calibration plot (B) of the nomogram for the prediction of cancer-specific survival in the validation cohort
Fig. 5
Fig. 5
Decision curve analysis for the nomogram (A) and tumor stage and grade (Ta/T1/Tis/LG/HG) (B) in the prediction of 5-year cancer-specific survival in the validation cohort
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