Understanding the long-term impact of the COVID-19 pandemic on non-muscle-invasive bladder cancer outcomes: 12-Month follow-up data from the international, prospective COVIDSurg Cancer study

Abstract

Objective: The objective of this study was to report the 12-month oncological outcomes for patients with non-muscle-invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study.

Patients and methods: Eligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site-declared delay to surgery from diagnosis as a consequence of COVID-19 and deviation in standard care due to COVID-19. Comparisons were made to cohorts from the pre-pandemic era.

Results: Bladder cancer accounted for 2.2% (n = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12-month follow-up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high-risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high-risk pre-pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12-month progression rate of 3.5%. As a consequence of the COVID-19 pandemic, 10.9% of patients had site-declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high-risk disease; and 18.3% had a delay to cystoscopic follow-up surveillance.

Conclusions: This prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12-month oncological outcomes appear to be impaired compared to published pre-pandemic outcomes.

Keywords: COVID‐19; bladder cancer; delay; non‐muscle invasive; pandemic; surgery.

FIGURE 1

Flowchart of included patients.

FIGURE 2

Multivariate model assessing the independent association between COVID‐19 related delay to surgery and disease recurrence at 12 months. CIS, carcinoma in situ; NICE, National Institute for Health and Care Excellence.

FIGURE 3

Comparison of 12‐month recurrence rates between COVID‐Surg NMIBC cohort and International Bladder Cancer Group High‐Risk (2006 EORTC scoring model). *COVID‐Surg NMIBC cohort applied UK National Institute for Health and Care Excellence (NICE) risk stratification with this cohort composed of 47% high‐risk, 24% intermediate‐risk and 28% low‐risk disease patients. **The International Bladder Cancer Group (IBCG) estimated the recurrence rate at 12 months using European Organisation for Research and Treatment of Cancer (EORTC) data for those with high‐risk disease, defined as those with histologically confirmed T1 and/or high‐grade disease and/or carcinoma in situ (CIS) for patients that had not yet undergone Bacillus Calmette‐Guerin (BCG).

FIGURE 4

Comparison of 12‐month progression rates between COVID‐Surg NMIBC cohort and EAU Prognostic High‐Risk Group (2021 EAU NMIBC scoring model). *COVID‐Surg NMIBC cohort applied UK National Institute for Health and Care Excellence (NICE) risk stratification with this cohort composed of 47% high risk, 24% intermediate risk and 28% low risk. **The European Association of Urology developed a scoring model to calculate NMIBC disease progression, with high risk defined as all T1/HG/G3 disease without carcinoma in situ (CIS) except those in very high‐risk group; all CIS patients except those in very high‐risk group; and the inclusion of other stages/grades where there is the presence of additional risk factors (2021 EAU NMIBC scoring model).