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01-11-2023 | Urology - Original Paper

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

Authors: Makito Miyake, Nobutaka Nishimura, Yuichi Nishioka, Tomomi Fujii, Yuki Oda, Tatsuki Miyamoto, Mitsuru Tomizawa, Takuto Shimizu, Takuya Owari, Kenta Ohnishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Kazumasa Torimoto, Nobumichi Tanaka, Tomoaki Imamura, Kiyohide Fujimoto

Published in: International Urology and Nephrology | Issue 3/2024

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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Title: Clinical impact of the intensity of follow-up cystoscopy in patients with high-risk non-muscle-invasive bladder cancer
Authors: Makito Miyake
Nobutaka Nishimura
Yuichi Nishioka
Tomomi Fujii
Yuki Oda
Tatsuki Miyamoto
Mitsuru Tomizawa
Takuto Shimizu
Takuya Owari
Kenta Ohnishi
Shunta Hori
Yosuke Morizawa
Daisuke Gotoh
Yasushi Nakai
Kazumasa Torimoto
Nobumichi Tanaka
Tomoaki Imamura
Kiyohide Fujimoto
Publication date: 01-11-2023
Publisher: Springer Netherlands
Published in: International Urology and Nephrology / Issue 3/2024
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-023-03851-3

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Abstract

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