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Clinical impact of the intensity of follow-up cystoscopy in patients with high-risk non-muscle-invasive bladder cancer

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

There is significant lack on evidence regarding the effect of non-adherence to a recommended protocol in follow-up of high-risk non-muscle-invasive bladder cancer (NMIBC), or the impact of delaying detection of recurrent lesion. Here, we aimed to investigate the optimal frequency of follow-up cystoscopy of high-risk NMIBC with respect to oncological safety in the Japanese real-world clinical practice.

Methods

This retrospective single-center study included 206 patients with primary high-risk NMIBC. The intensity (%) of follow-up cystoscopy was calculated based on actual visits for cystoscopy and guideline-recommended frequency in the first 24-month follow-up period. Inverse probability of treatment weighting analyses was used to reduce the risk of bias between groups. We performed a restricted cubic spline analysis with knots at intensity of follow-up cystoscopy ≤ 100% group to examine the possible association of progression risk with the intensity of follow-up as a continuous exposure.

Results

The median intensity was 87.5% (interquartile range, 75–100). Adjusted multivariate analysis for MIBC-free and progression-free survival demonstrated no significant difference between adjusted ≤ 75% and > 75% intensity groups. A restricted cubic spline analysis suggested no significant effect of the intensity of follow-up on progression risk, and hazard ratios of patients of < 100% intensity were equivalent to those of patients of 100% intensity.

Conclusion

Our finding suggested decreased intensity of follow-up cystoscopy did not affect oncological outcomes in patients with high-risk NMIBC. Further prospective trials directly aimed at investigating optimized follow-up schedules for NMIBC are mandatory before substantial changes to existing clinical guidelines.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

BC:

Bladder cancer

BCG:

Bacillus Calmette–Guérin

CI:

Confidence interval

CIS:

Carcinoma in situ

FISH:

Fluorescent in situ hybridization

HR:

Hazard ratio

iBCG:

Induction bacillus Calmette–Guérin

IPTW:

Inverse probability of treatment weighted

JUA:

Japanese Urological Association

LVI:

Lymphovascular invasion

NMIBC:

Non-muscle-invasive bladder cancer

MIBC:

Muscle-invasive bladder cancer

RCS:

Restricted cubic spline

TURBT:

Transurethral resection of bladder tumor

UC:

Urothelial carcinoma

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan

    Makito Miyake, Nobutaka Nishimura, Yuki Oda, Tatsuki Miyamoto, Mitsuru Tomizawa, Takuto Shimizu, Takuya Owari, Kenta Ohnishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Kazumasa Torimoto, Nobumichi Tanaka & Kiyohide Fujimoto

  2. Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan

    Yuichi Nishioka & Tomoaki Imamura

  3. Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan

    Tomomi Fujii

  4. Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan

    Nobumichi Tanaka

Authors
  1. Makito Miyake
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  2. Nobutaka Nishimura
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  4. Tomomi Fujii
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  6. Tatsuki Miyamoto
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  14. Yasushi Nakai
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  15. Kazumasa Torimoto
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  16. Nobumichi Tanaka
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  18. Kiyohide Fujimoto
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Contributions

All authors contributed to the study conception and design. Conceptualization: Makito Miyake. Methodology: Nobutaka Nishimura, Yuichi Nishioka. Formal analysis and investigation: Tomomi Fujii, Yuki Oda, Tatsuki Miyamoto, Mitsuru Tomizawa, Takuto Shimizu, Takuya Owari, Kenta Ohnishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Kazumasa Torimoto. Writing—original draft preparation: Makito Miyake. Writing—review and editing: Nobumichi Tanaka, Kiyohide Fujimoto. Supervision: Tomoaki Imamura. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Makito Miyake.

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Miyake, M., Nishimura, N., Nishioka, Y. et al. Clinical impact of the intensity of follow-up cystoscopy in patients with high-risk non-muscle-invasive bladder cancer. Int Urol Nephrol 56, 827–837 (2024). https://doi.org/10.1007/s11255-023-03851-3

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  • DOI: https://doi.org/10.1007/s11255-023-03851-3

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