Surveillance for Nonmuscle Invasive Bladder Cancer: Identifying the Point of Diminishing Returns

Daniel Ranti, Linda Dey, Christine Bieber, Ralph Grauer, Jordan Rich, Shoshana Rosenzweig, Lotta Renström Koskela, Gunnar Steineck, Abolfazl Hosseini, Lars Egevad, Jaakko Patrakka, Kyrollis Attalla, Peter Wiklund, John Sfakianos, Nikhil Waingankar

Research output: Contribution to journalArticlepeer-review


Objective: To characterize first and second recurrence patterns using 26 years of cohort-level follow-up and microsimulation modeling. Methods: Patients diagnosed with nonmuscle-invasive bladder cancer in Stockholm County between 1995 and 1996 were included. Clinical, pathological, and longitudinal follow-up data were gathered. Logistic regressions, Kaplan Meier curves, and Cox proportional hazards models were run to generate assumptions for a microsimulation model, simulating first and second recurrence and progression for 10,000 patients. Results: Three hundred eighty-six patients were included: 67.4% were male; >50% were TaLG; and 37.5% were American Urological Association high-risk. Median time to recurrence was 300 days. Three patients had missing data. Cohort follow-up has been carried out for 26 years. For simulated first-recurrences, low-risk patients recurred at 56.6% over 15 years of follow-up, with 2.2% muscle-invasive (MI) progression; intermediate-risk patients recurred at 62.8%, with 4.3% MI progression; high-risk patients recurred at 48.7% over 15 years, with MI progression at 14.3%. For second recurrences, 70.7%, 75.7%, and 84.7% of low, medium, and high-risk patients recurred. No patients were seen to have first recurrences after 9 years, with low, but notable, rates beyond 5 years. Conclusion: These data suggest that low-, intermediate-, and high-risk patients without recurrence at 5 years may be potentially transitioned to less invasive monitoring.

Original languageEnglish
Pages (from-to)84-91
Number of pages8
StatePublished - Nov 2023


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