Non-muscle-invasive recurrences were common during bladder-sparing surveillance but did not predict progression

Design

Retrospective analysis of a prospectively maintained surveillance database

Population

61 patients with MIBC and clinical complete response to neoadjuvant cisplatin chemotherapy

Primary outcome

Non-muscle-invasive recurrences and their management

Effect

28 of 61 recurred (46 recurrences, 80% high grade); no association with later muscle-invasive or metastatic relapse

This retrospective review of a prospectively maintained database followed 61 patients with muscle-invasive bladder cancer who achieved a clinical complete response to cisplatin-based neoadjuvant chemotherapy — negative resection, cytology and imaging — and entered strict active surveillance instead of cystectomy.

Over a median 28.3 months, 28 patients had a total of 46 non-muscle-invasive recurrences, 80% of them high grade. Most high-grade recurrences (60%) were treated with BCG induction. Non-muscle-invasive recurrence was not associated with later muscle-invasive recurrence or metastasis.

For patients unfit for or declining cystectomy, this suggests a superficial recurrence during surveillance can usually be treated as non-muscle-invasive disease rather than a signal to abandon bladder preservation. The cohort is small, from one programme, and follow-up is short for bladder cancer, so the absence of an association with progression is not strong reassurance.

• Keep patients on bladder-sparing surveillance on a strict cystoscopy, cytology and imaging schedule
• Treat non-muscle-invasive recurrence as such, including BCG for high-grade disease
• Re-stage carefully to exclude muscle invasion at every recurrence
• Discuss the high recurrence rate before patients choose surveillance

Why it matters

A superficial recurrence need not end bladder preservation, which matters for patients who cannot or will not have cystectomy.

Don't overread it

A 61-patient single-programme series — too small and short to show recurrence is safe in the long term.

The statistics, in plain English

46% of patients recurred, but with only 61 patients and a median follow-up just over two years, the study cannot rule out a modest link between superficial recurrence and later progression.

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