‘Very‐low‐risk’ bladder tumours – a new entity?

Objective To evaluate the homogeneity of the ‘low‐risk’ bladder cancer group in an attempt to optimise follow‐up protocols. Patients and Methods Between June 1998 and December 2008, 211 patients (mean [sd] age of 66.7 [12.8] years) underwent transurethral resection of low‐risk bladder cancer. Postoperative follow‐up included cystoscopy at 3 and 12 months after surgery, then annually for a total of 5 years, and then annual ultrasonography indefinitely. Results After a median follow‐up of 10 years, 65 patients (30.7%) developed tumour recurrence and three (1.4%) stage progressions. In all, 84 patients (40%) had tumours of ≤1 cm; these patients were significantly younger than patients with 1.1–3 cm tumours (64.6 vs 68.3 years, P = 0.03). Their 5‐year recurrence‐free survival rate was significantly higher (92% vs 70% in patients with larger tumours, P < 0.001). The median time to recurrence was 5.7 years in patients with smaller tumours and 3.6 years in patients with larger tumours (P = 0.03). Only 43.7% of the recurrences in patients with small tumours occurred within 5 years, compared to 75.5% in patients with larger tumours. Conclusions Patients with low‐risk bladder cancer make an inhomogeneous group. They can be stratified according to tumour size. Patients with tumours of ≤1 cm are younger, have lower risk of tumour recurrence, and most of their recurrences arise beyond the recommended 5‐year surveillance period. It seems that these patients can be classified separately to a ‘very‐low‐risk’ group. Follow‐up in these cases can be based on prolonged non‐invasive evaluations.