Analysis of Risk Factors for Recurrence after Transurethral Resection of Bladder Tumor in Patients with Non-Muscle Invasive Bladder Cancer: 2-Year Follow-Up Outcomes
Authors: Li Hecheng , Wang Li , Li Hongliang , Zhang Peng , Li Zhaolun , Xue Li , Wang Zhenlong , Fu Delai , Chen Qi , Luo Qidong , Chong Tie , Wang Ziming 
Published: October 2023

<b><i>Introduction:</i></b> The aim was to investigate the risk factors for recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to provide a basis for clinical prevention of recurrence of NMIBC. <b><i>Methods:</i></b> From January 2012 to December 2020, 592 patients with NMIBC who underwent TURBT attending the Second Affiliated Hospital of Xi’an Jiaotong University were retrospectively included in this study. Patients were divided into relapse and relapse-free groups according to whether relapse occurred within 2 years. Ultimately, 72 patients were included in the relapse group and 350 patients were included in the relapse-free group. Observation indicators included age, sex, smoking, underlying disease (hypertension, diabetes, coronary heart disease), two or more lesions, tumor size, hematuria, pathology grading (low, medium, high), staging (Ta, T1), muscular invasion in initial pathology, tumor base (sessile, pedunculated), use of intravesical drug (pirarubicin, bacillus Calmette-Guerin [BCG], mitomycin, hydroxycamptothecin, gemcitabine). <b><i>Results:</i></b> In this study, the 2-year recurrence rate of NMIBC patients after TURBT was 17.06%. There were significant differences in comparison of pirarubicin, BCG, and mitomycin treatment between the two groups (<i>p</i> &lt; 0.05). To avoid missing risk factors for recurrence, factors with <i>p</i> &lt; 0.1 were analyzed. The results of univariate logistic regression analysis showed that NMIBC patients with BCG treatment (OR = 5.088, 95% CI = 1.444–17.73, <i>p</i> = 0.012), high pathology grading (OR = 0.415, 95% CI = 0.197–0.880, <i>p</i> = 0.023), T1 stage (OR = 2.097, 95% CI = 0.996–4.618, <i>p</i> = 0.059), mitomycin treatment (OR = 5.029, 95% CI = 1.149–21.77, <i>p</i> = 0.031), and pirarubicin treatment (OR = 1.794, 95% CI = 1.079–3.030, <i>p</i> = 0.024) had significantly higher risk of recurrence within 2 years after TURBT. The results of multivariate logistic regression analysis showed that NMIBC patients with high pathology grading (OR = 0.4030, 95% CI = 0.1702–0.8426, <i>p</i> = 0.0241), pirarubicin treatment (OR = 1.961, 95% CI = 1.159–3.348, <i>p</i> = 0.0125), and BCG treatment (OR = 6.201, 95% CI = 1.275–29.73, <i>p</i> = 0.0190) had significantly higher risk of recurrence within 2 years after TURBT. <b><i>Conclusion:</i></b> Our study highlights the importance of postoperative surveillance and individualized treatment for patients with NMIBC. Our findings show that high pathology grading, pirarubicin treatment, and BCG treatment are independent risk factors for recurrence after TURBT in patients with NMIBC. However, caution is warranted when interpreting our findings due to the small sample size and the need for further research to confirm the negative impact of mitomycin and BCG on recurrence rates.