Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer

Lars Holmberg; Oskar Hagberg; Christel Häggström; Truls Gårdmark; Viveka Ströck; Firas Aljabery; Staffan Jahnson; Abolfazl Hosseini; Tomas Jerlström; Amir Sherif; Karin Söderkvist; Anders Ullén; Mats Enlund; Fredrik Liedberg; Per-Uno Malmström

doi:10.1371/journal.pone.0274859

Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer

PLoS One. 2022 Sep 23;17(9):e0274859. doi: 10.1371/journal.pone.0274859. eCollection 2022.

Authors

Lars Holmberg^{1

2}, Oskar Hagberg³, Christel Häggström^{1

4}, Truls Gårdmark⁵, Viveka Ströck⁶, Firas Aljabery⁷, Staffan Jahnson⁷, Abolfazl Hosseini⁸, Tomas Jerlström⁹, Amir Sherif¹⁰, Karin Söderkvist¹¹, Anders Ullén^{8

12}, Mats Enlund^{1

13}, Fredrik Liedberg^{3

14}, Per-Uno Malmström¹

Affiliations

¹ Department of surgical Sciences, Uppsala, University, Uppsala, Sweden.
² School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
³ Department of Translational Medicine, Lund University, Malmö, Sweden.
⁴ Department of Public Health and Clinical Medicine, Northern Register Centre, Umeå University, Umeå, Sweden.
⁵ Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
⁶ Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
⁸ Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
⁹ Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
¹⁰ Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
¹¹ Department of Radiation Sciences, Umeå University, Umeå, Sweden.
¹² Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
¹³ Region Västmanland, Center for Clinical Research, Hospital of Västmanland, Uppsala University, Västerås, Sweden.
¹⁴ Department of Urology, Skåne University Hospital, Malmö, Sweden.

Abstract

Background: Previous research has associated repeated transurethral procedures after a diagnosis of non-muscle invasive bladder cancer (NMIBC) with increased risk of death of causes other than bladder cancer.

Aim: We investigated the overall and disease-specific risk of death in patients with NMIBC compared to a background population sample.

Methods: We utilized the database BladderBaSe 2.0 containing tumor-specific, health-related and socio-demographic information for 38,547 patients with NMIBC not primarily treated with radical cystectomy and 192,733 individuals in a comparison cohort, matched on age, gender, and county of residence. The cohorts were compared using Kaplan-Meier curves and Hazard ratios (HR) from a Cox regression models. In the NMIBC cohort, we analyzed the association between number of transurethral procedures and death conditioned on surviving two or five years.

Results: Overall survival and survival from causes other than bladder cancer estimated with Kaplan-Meier curves was 9.3% (95% confidence interval (CI) (8.6%-10.0%)) and 1.4% (95% CI 0.7%-2.1%) lower respectively for the NMIBC cohort compared to the comparison cohort at ten years. In a Cox model adjusted for prognostic group, educational level and comorbidity, the HR was 1.03 (95% CI 1.01-1.05) for death from causes other than bladder cancer comparing the NMIBC cohort to the comparison cohort. Among the NMIBC patients, there was no discernible association between number of transurethral procedures and deaths of causes other than bladder cancer after adjustment. The number of procedures were, however, associated with risk of dying from bladder cancer HR 3.56 (95% CI 3.43-3.68) for four or more resections versus one within two years of follow-up.

Conclusion: The results indicate that repeated diagnostic or therapeutic transurethral procedures under follow-up do not increase of risk dying from causes other than bladder cancer. The modestly raised risk for NMIBC patients dying from causes other than bladder cancer is likely explained by residual confounding.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cystectomy / methods
Humans
Neoplasm Invasiveness
Neoplasm Recurrence, Local / diagnosis
Prognosis
Retrospective Studies
Urinary Bladder / surgery
Urinary Bladder Neoplasms* / diagnosis

Grants and funding

This work was supported by the Swedish Cancer Society (grant numbers CAN 2019/62 (LH) and CAN 2020/0709 (FL)), Swedish Research Council (2021-00859)(FL), Lund Medical Faculty (ALF)(FL), and Skåne County Council’s Research and Development Foundation (FL). The funding sources had no role in the study design, data analyses, interpretation of the results, or writing of the manuscript. Swedish Cancer Society: Cancerfonden.se Swedish Research Council: vr.se Lund Medical Faculty: lu.se Skåne County: Skane.se.