Risk factors for recurrence after initial transurethral resection of bladder tumor in patients with non–muscle-invasive bladder cancer

Abstract

Recurrence remains common after initial transurethral resection of bladder tumor (TURBT) for non–muscle-invasive bladder cancer (NMIBC). This study aimed to identify routinely available clinicopathological, treatment-related, and inflammatory factors associated with recurrence and to characterize recurrence-free survival (RFS). This retrospective cohort included patients with pathologically confirmed Ta, T1, or primary carcinoma in situ (CIS) who underwent initial TURBT between January 2017 and December 2023. Multivariable logistic regression was used as the primary analysis to evaluate factors associated with documented recurrence during follow-up. Cox proportional hazards regression was performed as a complementary analysis incorporating recurrence timing and censoring. Kaplan–Meier analysis, sensitivity analyses, restricted cubic spline analysis, time-dependent receiver operating characteristic analysis, and bootstrap-corrected model evaluation were also performed. Among 605 patients, 237 (39.2%) experienced recurrence during a median follow-up of 34.0 months. Multiple tumors were associated with higher recurrence odds and hazard (adjusted odds ratio [OR], 1.88; 95% confidence interval [CI], 1.27–2.78; adjusted hazard ratio [HR], 1.62; 95% CI, 1.25–2.10). Higher recurrence odds and hazards were also associated with increasing tumor diameter, T1 or primary CIS, high-grade pathology, concomitant CIS, and higher baseline neutrophil-to-lymphocyte ratio. Maintenance intravesical therapy was inversely associated with recurrence (adjusted OR, 0.49; 95% CI, 0.34–0.72; adjusted HR, 0.62; 95% CI, 0.47–0.81). Estimated RFS rates were 81.5%, 63.8%, and 54.1% at 1, 3, and 5 years, respectively. The bootstrap-corrected area under the curve was 0.769 for the logistic model, and the bootstrap-corrected Harrell’s C-index was 0.739 for the Cox model. Recurrence after initial TURBT was associated with greater tumor burden, adverse pathological characteristics, concomitant CIS, and higher baseline neutrophil-to-lymphocyte ratio. Maintenance intravesical therapy showed an inverse observational association with recurrence. These routinely available factors may support postoperative risk stratification and risk-adapted surveillance.