MANAGEMENT OF SUPERFICIAL BLADDER CANCER IN VICTORIA: 1990 AND 1995

• Published in: ANZ journal of surgery 2005-05, Vol.75 (5), p.270-274
• Main Authors: Frydenberg, Mark, Millar, Jeremy L., Toner, Guy, Bolton, Damien, Syme, Rodney, Thursfield, Vicky J., Giles, Graham G.
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - epidemiology; Carcinoma, Transitional Cell - therapy; Cystoscopy; Disease-Free Survival; Excretory system; Female; Humans; Male; management; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Practice Guidelines as Topic; Prognosis; recurrence; Registries; Retrospective Studies; superficial bladder cancer; Surgery; Survival Analysis; Treatment Outcome; Tumors; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - therapy; Victoria - epidemiology
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2005.03347.x

Background:  A retrospective survey of medical practitioners was undertaken to describe the tumour characteristics, management and outcomes of all superficial bladder cancers newly diagnosed in 1990 and in 1995 in Victoria. Methods:  Cases were identified from the population cancer registry. The survey was conducted in 1999 and the cohort followed up until 2000 to obtain at least 5 years of follow‐up data on all patients, in particular to identify recurrence of tumour as assessed at surveillance cystoscopy and progression to muscle invasive cancer. Results:  Tumour recurrence was observed in 390/610 patients (63.9%), of whom 56.9% had their recurrence noted at the first check cystoscopy. Ultimately 43 (6.3%) of patients progressed to invasive disease, with this subgroup demonstrating 5‐year overall survival of 35% (95% confidence interval (CI) 21–49%). Ultimately survival was proportional to the extent of tumour invasion, being greater in low‐risk patients (76%, 95% CI 72–80%, mucosal disease only) than in high‐risk patients (46%, 95% CI 36–56%, lamina propria invasion noted at diagnosis). Conclusions:  In low‐risk subgroups of patients with superficial transitional cell carcinoma, the frequency of surveillance cystoscopy may be able to be reduced to levels in accordance with established European guidelines without a likely impact on patient survival. Where progression to muscle invasive disease does ensue, more aggressive management may be warranted in order to try to improve survival.