To assess current treatment strategies for T1 high-grade bladder cancer and conclude a single-center study based on 14-year treatment outcomes of actual T1 high-grade bladder cancer cases.

A retrospective analysis was conducted on bladder cancer patients who underwent TURBt at our institution between 2010 and 2023, with a definitive postoperative pathology diagnosis of primary T1HG bladder cancer. Baseline data, clinicopathological characteristics, postoperative adjuvant treatments, and tumor prognosis were collected to assess patient outcomes, and factors associated with recurrence were examined. Survival probabilities for the outcome measures were calculated using the Kaplan-Meier method and presented with estimates and 95% confidence intervals (CIs). Univariate analysis was conducted using the independent samples t-test for continuous variables and the chi-square test for categorical data to evaluate the association between potential factors and tumor recurrence. Binary logistic regression was applied for multivariable analysis to assess the impact of multiple factors on tumor recurrence. Additionally, the conditional Cox regression model was used as proposed by Prentice, Williams, and Peterson (PWP). Survival analysis plots were generated using Prism 10.1.2, and all statistical tests were two-sided, with significance evaluated at the 5% level using SPSS 27.0.

We included 165 patients in the study, with 132 males (80%) and 33 females (20%). The average age at the time of surgery was 67.5 ± 9.9 years, and the average BMI was 24.8 ± 3.4. The study found that tumor recurrence in patients with T1HG bladder cancer was significantly associated with postoperative BCG treatment (OR = 0.315, P = 0.001) and tumor multiplicity (OR = 0.476, P = 0.033). In the group of patients who received postoperative BCG treatment, tumor recurrence was significantly correlated with tumor multiplicity (OR = 0.328, P = 0.027), and elevated BMI was found to potentially accelerate the recurrence process (HR = 1.098, P = 0.01). The 10-year recurrence-free survival (RFS) for all patients was 54.9% (95% CI: 44.3%-65.5%), with a median RFS of 134 months (95% CI: 64.7-203.3). The 10-year progression-free survival (PFS) was 87.2% (95% CI: 81.0%-93.5%), the 10-year overall survival (OS) was 66.7% (95% CI: 54.0%-79.4%), the 10-year cancer-specific survival (CSS) was 93.7% (95% CI: 88.4%-99.0%), and the 10-year cystectomy-free survival rate was 86.3% (95% CI: 79.8%-92.8%). In patients who received postoperative BCG treatment, the 5-year RFS was 65.7% (95% CI: 50.6%-80.8%), the 5-year PFS was 92.9% (95% CI: 86.6%-99.2%), the 5-year OS was 83% (95% CI: 70.5%-95.5%), the 5-year CSS was 97.2% (95% CI: 92%-100%), and the 5-year cystectomy-free survival rate was 90% (95% CI: 80.4%-99.6%). The impact of BCG treatment on cystectomy-free survival was statistically significant (P = 0.01).

Tumor recurrence in patients with T1HG bladder cancer was associated with both the use of BCG therapy and tumor multiplicity, and an elevated BMI may accelerate the recurrence process.

Recurrence of T1HG bladder cancer tumors is a key issue, with disease progression and mortality posing a lower threat than recurrence. Tumor recurrence in T1HG bladder cancer is associated with the use of BCG treatment and tumor multiplicity. In patients who have received BCG treatment, recurrence is linked to tumor multiplicity. Additionally, an increase in BMI may accelerate the recurrence process. A comprehensive review of recurrence factors and treatment approaches for T1HG bladder cancer suggests that future research should involve larger sample sizes, mechanistic studies, and multicenter collaborations to enable precise treatment. Currently, TURBt combined with bladder-sparing BCG induction and maintenance therapy, or radical cystectomy, remains the standard of care.

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