[Mid-term results of a program for the monitoring of superficial bladder tumors].

OBJECTIVE: To identify the medium-term clinical prognostic factors for recurrence and progression in superficial bladder tumors and to analyze the efficacy and safety of the surveillance program. METHODS: 135 patients with primary superficial bladder tumor (Ta: 57, T1: 76, Tx: 2, grade I: 51, grade II: 70, grade III: 12, unknown grade: 2) were evaluated by cystoscopy/cytology alternately with ultrasound/cytology during the first two years, and by ultrasound and cytology yearly after the third year. The influence of tumor characteristics (stage, grade, size and number) and patient age and sex on tumor recurrence and progression were analyzed. The disease-free interval was expressed through an actuarial curve. The relationships between the annual recurrence rate and disease-free interval, and tumor and patient characteristics were analyzed. The influence of each variable in the presence of the other covariables was determined by multivariative analysis using a logistic regression model. RESULTS: The recurrence rate was 51.3% and the progression rate was 2.75%. The mean recurrence rate was 0.59 and the mean disease-free interval was 16.2 months. Tumor grade, size and number significantly influenced recurrence. Tumor size and number influenced the annual recurrence rate. Similarly, tumor number and size were associated with a shorter disease-free interval. Logistic regression analysis showed a relationship between tumor number and recurrence (relative risk = 2.7), and identified tumor size as a characteristic of a high recurrence rate (relative risk = 3.3). None of the factors could predict a higher risk for tumor progression. CONCLUSIONS: The estimation of the risk factors shows a wide intra and interindividual variability. It might therefore be necessary to establish them for each institution. In the medium-term, surveillance can be considered effective in terms of the recurrence rate and safe in terms of the progression rate.