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The Impact of Non-Compliance to a Standardized Risk-Adjusted Protocol on Recurrence, Progression, and Mortality in Non-Muscle Invasive Bladder Cancer

Authors Abushamma F, Khayyat Z, Soroghle A, Zyoud SH, Jaradat A, Akkawi M, Aburass H, Qaddumi IKK, Odeh R, Salameh H, Albuheissi S

Received 10 January 2021

Accepted for publication 10 March 2021

Published 31 March 2021 Volume 2021:13 Pages 2937—2945


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Bilikere Dwarakanath

Faris Abushamma,1– 3 Zain Khayyat,1 Aya Soroghle,1 Sa’ed H Zyoud,4,5 Ahmad Jaradat,1,2 Maha Akkawi,1,6 Hanood Aburass,1,6 Iyad KK Qaddumi,7 Razan Odeh,8 Husam Salameh,8 Salah Albuheissi3

1Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine; 2Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine; 3Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; 4Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, an-Najah National University, Nablus, 44839, Palestine; 5Clinical Research Center, an-Najah National University Hospital, Nablus, 44839, Palestine; 6Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine; 7Department of Urology, Rafedia General Hospital, Nablus, 44839, Palestine; 8Department of Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine

Correspondence: Faris Abushamma
Department of Medicine, College of Medicine and Health Sciences, an-Najah National University, Nablus, 44839, Palestine
Email [email protected]

Purpose: Non-muscle invasive bladder cancer (NMIBC) is a potentially curable or controllable disease if strict adherence to a surveillance protocol is followed. Management and surveillance of NMIBC begins at the time of diagnosis up to a few years thereafter. There is scanty data in the literature evaluating the impact of non-compliance with the surveillance protocols on progression, recurrence, and mortality rate.
Patients and Methods: An observational, retrospective cohort study recruited data between 2012 and 2017 at two tertiary hospitals. Data were collected consecutively. NMIBC patients who had at least 3 years of follow-up data were included. Patients were divided into different groups based on their compliance with the cystoscopy follow-up protocol as recommended by the European guidelines. We compared the cystoscopy compliant group with the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance were calculated using a new scoring model to predict adverse outcomes.
Results: Eighty-eight NMIBC patients met our criteria. Recurrence rate (RR), progression rate (PR), metastasis rate (MsR), and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (P< 0.001), PR: (54.1%) (P< 0.001), MsR: (37.7%) (P< 0.001), MR: (23.5%) (P= 0.002) respectively. In the subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group, while it is 100% (P< 0.001) and 56.4% (P=0.001) in the non-compliant group, respectively. Use of a Kaplan Meier (KM) graph shows that compliant patients had a better survival in comparison to non-compliant patients. Scoring there or more is statistically and clinically significantly associated with higher recurrence, progression, and mortality. RR: (94%) (P=0.016), PR: 49% (P< 0.001) and MR (26%) (P=0.012).
Conclusion: Non-compliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group. This mandates strict adherence to surveillance guidelines particularly in patients with high-risk disease.

Keywords: NMIBC, COVID-19, urological malignancies, haematuria

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