Real-world management of T1 high-grade bladder cancer: A 14-year retrospective single-center study

Background: T1 high-grade (T1HG) bladder cancer (BC) carries substantial risks of recurrence and progression, deserving of heightened clinical attention. Objective: The present study evaluated the management approaches and reported 14-year real-world outcomes in patients with T1HG BC from a single-center cohort. Methods: Data were retrospectively collected from primary T1HG patients who had undergone transurethral resection of bladder tumors (TURBT) at our institution between 2010 and 2023. A total of 165 patients were included. Their baseline characteristics, pathological findings, adjuvant therapies, recurrence, progression, and survival outcomes were analyzed. Predictors of tumor recurrence were modeled using multivariable analyses. Results: Tumor recurrence was significantly associated with post-operative Bacillus Calmette–Guérin (BCG) treatment (odds ratio [OR]: 0.315, p=0.001) and tumor multifocality (OR: 0.476, p=0.033). Among patients having received post-operative BCG treatment, tumor recurrence bore a significant correlation with tumor multifocality (OR: 0.328, p=0.027), and elevated body mass index (BMI) was identified as a potential accelerator of recurrence (hazard ratio: 1.098, p=0.01). The 10-year recurrence-free survival rate among all patients stood at 54.9% (95% confidence interval [CI]: 44.3–65.5%), with a median of 134 months (95% CI: 64.7–203.3 months). The rate of re-TURBT was 20%. The 10-year progression-free survival was 87.2% (95% CI: 81.0–93.5%) and the 10-year overall survival was 66.7% (95% CI: 54.0–79.4%). The 10-year cancer-specific survival and the 10-year cystectomy-free survival (CFS) rates were 93.7% (95% CI: 88.4–99.0%) and 86.3% (95% CI: 79.8–92.8%), respectively. Notably, BCG treatment significantly improved CFS (p=0.01). Conclusion: Recurrence in T1HG disease is associated with BCG therapy and tumor multifocality, with a high BMI potentially promoting relapse.