Pyuria Predicts Poor Prognosis in Patients With Non-Muscle-Invasive Bladder Cancer

Urothelial carcinoma of the bladder is the second most common genitourinary malignancy. Non-muscle-invasive bladder cancer (NMIBC) recurs in 15% to 70% of cases by 1 year. Several studies have shown some independent prognostic factors of recurrence. In this study, we evaluated the association between the presence of pyuria at the time of diagnosis and tumor recurrence and progression. Our results demonstrate that the addition of "pyuria" to the known European Organization for Research and Treatment of Cancer (EORTC) risk grouping may be clinically relevant. Background: To evaluate the significance of inflammation in non-muscle-invasive bladder cancer (NMIBC), we assessed the presence of pyuria at time of diagnosis. Patients and Methods: A cohort of 805 patients with newly diagnosed NMIBC between 1994 and 2007 at the Tokyo Metropolitan Tama Medical Center were enrolled in this retrospective study. Pyuria was defined as urine containing >= 10 white blood cells (WBCs) per high power field (HPF). Results: One hundred ninety-nine (24%) of the patients with NMIBC had pyuria. The 3-year recurrence-free survival rates of patients with and without pyuria were 10.9 vs. 45.0%, respectively. The 5-year progression-free survival rates of patients with and without pyuria were 72.3% and 95.7%, respectively. Multivariate Cox proportional hazards regression models indicated that pyuria was an independent predictor of disease recurrence and progression. After dividing the sample according to the European Organization for Research and Treatment of Cancer (EORTC) risk tables, we further classified patients into subgroups according to the presence of pyuria. The recurrence-free survival rates were higher in the pyuria-negative subgroups of the low, intermediate-low, intermediate-high, and high risk for recurrence groups. Similarly, the progression-free survival rates at 5 years were higher in the pyuria-negative subgroups of the low, intermediate-low, and intermediate-high risk for progression groups. Conclusion: Patients with inflammatory NMIBC exhibited poor clinical outcomes. (C) 2013 Elsevier Inc. All rights reserved.