Improving compliance with guidelines may lead to favorable clinical outcomes for patients with non-muscle-invasive bladder cancer - A retrospective multicenter study

Sep 24, 2026

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Clinical guidelines recommend appropriate adjuvant therapy for patients with non-muscle-invasive bladder cancer (NMIBC), yet adherence is often inadequate and may worsen outcomes. This retrospective multicenter study evaluated guideline adherence levels and compared recurrence-free survival between patients who did and did not receive guideline-recommended therapies. Among intermediate/high-risk tumors, maintenance BCG was frequently omitted, while maintenance BCG was associated with significantly better recurrence-free survival. In T1 NMIBC, few patients received both second TUR and maintenance BCG, and recommended-therapy recipients showed improved recurrence-free survival versus propensity-matched non-recipients.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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International Journal of Urology (2023) 30, 1155--1163 doi: 10.1111/iju.15294 Original Article Clinical Investigation Improving compliance with guidelines may lead to favorable clinical outcomes for patients with non-muscle-invasive bladder cancer: A retrospective multicenter study Takuma Sato, 1,2 Takeshi Sano,3 Sadafumi Kawamura,2,4 Yoshihiro Ikeda,2,5 Kazuhiko Orikasa,2,6 Takaki Tanaka,2,7 Atsushi Kyan,2,8 Shozo Ota,2,9 Satoru Tokuyama,2,10 Hideo Saito,2,11 Koji Mitsuzuka, 1,2 Shinichi Yamashita, 1,2 Yoichi Arai, 1,2 Takashi Kobayashi3 and Akihiro Ito 1,2 1Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan, 2Tohoku Urological EvidenceBased Medicine Study Group, Sendai, Japan, 3Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan, 4Department of Urology, Miyagi Cancer Center, Natori, Miyagi, Japan, 5Department of Urology, Osaki Citizen Hospital, saki, Miyagi, Japan, 6Department of Urology, Kesennuma City Hospital, Kesennuma, Miyagi, Japan, 7Department of Urology, Hachinohe City Hospital, Aomori, Japan, 8Department of Urology, Shirakawa Kosei General Hospital, Fukushima, Japan, 9Department of Urology, Sendai Red Cross Hospital, Sendai, Miyagi, Japan, 10Department of Urology, Iwaki City Medical Center, Fukushima, Japan, and 11Department of Urology, National Hospital Organization Sendai Medical Center, Miyagi, Japan Abbreviations & Acronyms BCG = bacillus Calmette–Gurin CIS = carcinoma in situ EAU = European Association of Urology EORTC = European Organization for Research and Treatment of Cancer IPIC = immediate postoperative instillation of chemotherapy IQR = interquartile range JUA = Japanese Urological Association MIBC = muscle-invasive bladder cancer NMIBC = non-muscle-invasive bladder cancer RCT = randomized controlled trial RFS = recurrence-free survival TUR = transurethral resection TURBT = transurethral resection of bladder tumor Correspondence Takuma Sato M.D., Ph.D., Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. Email: [takumasato@uro.med.tohoku](takumasato@uro.med.tohoku). [ac.jp](ac.jp) This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Received 21 February 2023; accepted 22 August 2023 . Online publication 4 September 2023 Objectives: Clinical guidelines recommend that patients with non-muscle-invasive bladder cancer (NMIBC) should be treated with appropriate adjuvant therapy. However, compliance with guideline recommendations is insufﬁcient, and this may lead to unfavorable outcomes. We aimed to investigate the level of adherence to guideline recommendations in patients with NMIBC and evaluate the outcomes of those who did and did not receive guideline-recommended therapies. Methods: We performed a retrospective analysis of patients with histologically diagnosed NMIBC. The percentage of patients with intermediate- and high-risk tumors who received adjuvant intravesical therapy or second transurethral resection (TUR) was calculated. Recurrence-free survival was assessed in patients who did and did not receive the therapies. We conducted a propensity score-matched analysis to compare outcomes between patients with intermediate-risk and T1 NMIBC who did and did not undergo guideline-recommended therapies. Results: Overall, 1204 patients from the Tohoku Urological Evidence-Based Medicine Study Group and Kyoto University Hospital were included. Of patients with intermediateand high-risk tumors, 91 .0% and 74 .0% did not receive maintenance bacillus Calmette– Gurin (BCG), respectively. In both groups, signiﬁcantly better recurrence-free survival was found for patients treated with maintenance BCG. Among patients with T1 NMIBC, only 16.7% underwent guideline-recommended

FAQs

What was the study’s main objective?

To assess how closely patients with NMIBC followed guideline-recommended therapies and to evaluate outcomes for those who did versus those who did not receive the recommended treatments.

How were guideline-recommended therapies evaluated in the study?

The study calculated the proportion receiving adjuvant intravesical therapy or a second transurethral resection (TUR) and then assessed recurrence-free survival among patients who did and did not receive these therapies.

Which therapies were linked to better recurrence-free survival?

Maintenance BCG was associated with significantly better recurrence-free survival in both intermediate/high-risk groups. Guideline-recommended therapies also showed significantly greater recurrence-free survival compared with propensity-matched patients who did not receive them.

Sep 24, 2026

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