LATE INVASIVE RECURRENCE DESPITE LONG-TERM SURVEILLANCE FOR SUPERFICIAL BLADDER-CANCER

Superficial transitional cell carcinoma of the bladder is associated w ith a 15 to 70% recurrence rate within 2 years. Most recurrences are s uperficial. A recurrence after 2 disease-free years is unusual. A revi ew of the tumor registry revealed 124 patients followed for superficia l disease at the Veterans Administration Center in Baltimore. Of the p atients 20 were identified with either stage Ta (7) or stage Tl (13) p apillary transitional cell carcinoma who had completed at least 5 year s of surveillance without tumor recurrence. Invasive transitional cell carcinoma of the bladder requiring cystectomy developed in 7 of these 20 patients after remaining tumor-free for 5 years (stage Ta in 4 and stage T1 in 3). All 7 patients had organ-confined disease and were al ive with no evidence of disease at 18 months to 5 years after cystecto my. These results demonstrate that superficial, low grade transitional cell carcinoma of the bladder can become muscle invasive despite care ful surveillance and a long dormant period. In our series yearly cysto scopy and urine cytology identified tumor recurrence before metastases developed, suggesting that long-term surveillance is required in pati ents with superficial bladder cancer.