Journal: Annals of surgical oncology
Study question
- – Does tumor location at the trigone or bladder neck affect outcomes in patients with high‑grade non–muscle-invasive bladder cancer (NMIBC) treated with TURBT and BCG?
Design and methods
- – Multicenter retrospective cohort of 1,796 patients with high‑grade NMIBC after TURBT plus adjuvant BCG.
- – Primary endpoints: high‑grade recurrence‑free survival (HG‑RFS) and progression‑free survival (PFS).
- – Key comparison: tumors involving the trigone or bladder neck vs other locations.
- – Propensity score matching was used to balance clinicopathologic factors.
- – External validation: 20,249 high‑grade NMIBC cases from SEER, evaluating overall and cancer‑specific survival (CSS) using competing‑risk methods.
Key patient characteristics
- – 75% had high‑grade T1 disease.
- – 48% had multiple tumors.
- – 35% had tumors involving the trigone or bladder neck.
Main findings
Testing cohort:
- – On multivariable analysis, trigone/bladder neck involvement was independently associated with worse HG‑RFS (HR 1.24, 95% CI 1.02–1.49).
- – After propensity matching, trigone/bladder neck involvement remained associated with:
- – Worse PFS (HR 1.45, 95% CI 1.00–2.09).
- – Worse HG‑RFS (HR 1.40, 95% CI 1.08–1.82).
External validation (SEER):
- – Tumors at the trigone (HR 1.22, 95% CI 1.09–1.38) and bladder neck (HR 1.37, 95% CI 1.19–1.58) were independently associated with worse cancer‑specific survival compared with other locations.
Clinical implication
- – Bladder trigone or neck involvement is an independent adverse prognostic factor in high‑grade NMIBC, associated with higher risk of high‑grade recurrence, progression, and cancer‑specific mortality.
- – The findings support incorporating tumor location (trigone/bladder neck) into risk stratification and highlight the need for further work on biological mechanisms and treatment implications (e.g., intensity of surveillance and consideration of early aggressive interventions in selected patients).