Presentation Authors: Rodolfo Hurle, Paolo Casale, Alberto Saita, NicoloMaria Buffi, Giovanni Lughezzani, Vittorio Fasulo, Davide Maffei, Marco Paciotti, Giulio Bevilacqua, Luigi Domanico, Silvia Zandegiacomo, Massimo Lazzeri*, Giorgio Guazzoni, Rozzano, Italy
Introduction: Active surveillance (AS) has been showed to be feasible and effective in a sub-set of patients with recurrent Low-Grade Non-Muscle Invasive Bladder Cancer (LG-NMIBC). The aim of this study is to up-date the clinical outcome and investigate the pathological results of patients who failed to remain under AS and required an endoscopic resection.
Methods: This is a prospective observational cohort study of patients with a previous pathologically confirmed LG NMIBC, who experienced recurrence during follow-up and accepted to undergo AS (protocol ICH/1390: Active surveillance for non-muscle invasive bladder cancer - Bladder Cancer Italian Active Surveillance - BIAS project). AS monitoring consisted of cytology and in-office flexible cystoscopy every 3 months for the first year, and then every six months annually. The primary end-point was to investigate the pathological results of patients who failed to remain in AS according to previous published criteria. The secondary outcome was to up-date the clinical results of our previous series. Data were complemented by descriptive statistical analysis and univariable and multivariable proportional hazard Cox regression.
Results: Overall 167 patients, for 181 AS events, were included. Sixty-one (33.7%) events over 181 were deemed to require treatment (TURBT) because positive cytology (#10), gross-haematuria (#11), increases of number (#15), of size (#17) or both (#8). The median time on AS was 14 months (IQI 5-26). Pathological specimens from failures did not show any malignancy in 20 cases. Negative histopathology resulted in urothelial hyperplasia and oedema, submucosal vascular ectasia, mucosal erosion, polypoid cystitis, von Brunn nests hyperplasia and squamous metaplasia. Time from first TUR to AS start was inversely associated with progression free survival (HR 0.97, 95% CI 0.96-1.00, p=0.024).
Conclusions: AS might be a reasonable strategy in patients presenting with small LG pTa/pT1a recurrent bladder tumours. About 30% of patients deemed failures did not present any neoplastic lesion. Further studies and new biomarkers are mandatory to avoid unnecessary TURBT.