The natural history of low risk non-muscle invasive bladder cancer: a collaborative multi-centre study
BAUS ePoster online library. Jaffer A. 11/10/20; 304232; P12-7 Disclosure(s): Nil
Mr. Ata Jaffer
Mr. Ata Jaffer
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The natural history of low risk non-muscle invasive bladder cancer: a collaborative multi-centre study

Jaffer A1, Lee M1, Khalil O1, Raslan M3, Rai S1, Kozan A4, Hannah M3, Bryan N4, Simms M3, Dooldeniya M6, Wilson J5, Jain S1, Chahal R2
1Leeds Teaching Hospital, United Kingdom, 2Bradford Teaching Hospital, United Kingdom, 3Hull Teaching Hospital, United Kingdom, 4Huddersfield Royal Infirmary, United Kingdom, 5York Teaching Hospital, United Kingdom, 6Pinderfields General Hospital, Wakefield, United Kingdom


Introduction: Current NICE guidance recommends discharging patients with low risk non-muscle invasive bladder cancer (LRNMIBC) who remain free of recurrence at 1 year of follow up. This has been met with some trepidation. In this collaborative study, we set out to assess the suitability of these guidelines to patients within our regional population.
Materials & methods:
A retrospective, multi-centre study involving 6 hospitals located across Yorkshire, England. Inclusion criteria was based on the NICE definition of LRNMIBC as per the 2015 guidance. Timeline of diagnosis ranged from 01/01/2012–30/06/2016.

Results:
In total, 412 patients were identified. 63.8% of the patients were graded as G2 (low-grade) pTa with the remaining 36.2% being G1pTa. Over a median follow up time of 36 months (IQR 25-50), the observed recurrence rate was 29.2%. 51.8% of patients developed their 1st recurrence beyond 1 year of surveillance. 4 patients (1%) progressed to muscle invasive disease with a further 7 (1.7%) progressing to high-risk NMIBC.

Conclusion:
The overall risk of recurrence and progression was similar to that observed in the EORTC data. We noted that the majority of patients developed a recurrence beyond 1 year of surveillance which challenges the current UK NICE guidance. Between 6 to 13 cystoscopies were required to detect a single recurrence which equates to £4122 - £8931 per recurrence detected (£687 per cystoscopy - 2011 NHS tariff). This figure would need to be taken into account if current NICE guidance was to be altered in favour of a prolonged surveillance program.
The natural history of low risk non-muscle invasive bladder cancer: a collaborative multi-centre study

Jaffer A1, Lee M1, Khalil O1, Raslan M3, Rai S1, Kozan A4, Hannah M3, Bryan N4, Simms M3, Dooldeniya M6, Wilson J5, Jain S1, Chahal R2
1Leeds Teaching Hospital, United Kingdom, 2Bradford Teaching Hospital, United Kingdom, 3Hull Teaching Hospital, United Kingdom, 4Huddersfield Royal Infirmary, United Kingdom, 5York Teaching Hospital, United Kingdom, 6Pinderfields General Hospital, Wakefield, United Kingdom


Introduction: Current NICE guidance recommends discharging patients with low risk non-muscle invasive bladder cancer (LRNMIBC) who remain free of recurrence at 1 year of follow up. This has been met with some trepidation. In this collaborative study, we set out to assess the suitability of these guidelines to patients within our regional population.
Materials & methods:
A retrospective, multi-centre study involving 6 hospitals located across Yorkshire, England. Inclusion criteria was based on the NICE definition of LRNMIBC as per the 2015 guidance. Timeline of diagnosis ranged from 01/01/2012–30/06/2016.

Results:
In total, 412 patients were identified. 63.8% of the patients were graded as G2 (low-grade) pTa with the remaining 36.2% being G1pTa. Over a median follow up time of 36 months (IQR 25-50), the observed recurrence rate was 29.2%. 51.8% of patients developed their 1st recurrence beyond 1 year of surveillance. 4 patients (1%) progressed to muscle invasive disease with a further 7 (1.7%) progressing to high-risk NMIBC.

Conclusion:
The overall risk of recurrence and progression was similar to that observed in the EORTC data. We noted that the majority of patients developed a recurrence beyond 1 year of surveillance which challenges the current UK NICE guidance. Between 6 to 13 cystoscopies were required to detect a single recurrence which equates to £4122 - £8931 per recurrence detected (£687 per cystoscopy - 2011 NHS tariff). This figure would need to be taken into account if current NICE guidance was to be altered in favour of a prolonged surveillance program.
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