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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 803-807. doi: 10.19723/j.issn.1671-167X.2026.04.017

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Impact of coexistent low-grade components on the prognosis of high-grade non-muscle invasive bladder cancer

Jiaxiang JI, Chinhui LAI, Fei WANG, Hao HU*()   

  1. Department of Urology, Peking University People's Hospital, Beijing 100044, China
  • Received:2024-03-18 Online:2026-08-18 Published:2026-02-25
  • Contact: Hao HU

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Abstract:

Objective: To evaluate the impact of coexisted low-grade components on the prognosis of patients with high-grade solitary primary non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was conducted on patients diagnosed with primary, solitary, high-grade non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT) at Peking University People' s Hospital between January 2015 and December 2019. All patients received single-dose intravesical chemotherapy within 24 hours after TURBT. Only patients accetpting adequate adjuvant intravesical chemotherapy were included for further analysis. Adequate intravesical chemotherapy was defined as weekly instillation for 8 weeks and monthly instillation for at least 6 months. All patients were strictly followed up according to the preestablished schedule with cystoscopic surveillance. The primary endpoint was recurrence free survival. Kaplan-Meier curve was used to compare the recurrence free survival of mHG group and pHG group. Univariable and multivariable Cox regression was conducted to evaluate the risk factors for tumor recurrence. Patients with variant histology, concurrent upper tract urothelial carcinoma, and incomplete resection which required re-TURBT were excluded. Patients without single instillation postoperative were also eliminated from the final cohort. Results: A total of 167 patients were enrolled in the final cohort, with 35 patients having mixed high-grade tumors (mHG) and 132 patients having pure high-grade tumors (pHG). The median follow-up time was 39.32 (26.82, 61.37) months. Baseline characteristics were well balanced between the two groups with regard to age, gender, pathological characteristics and instillation doses. Compared with the mHG group, the 5-year recurrence-free survival rate (RFS) of the pHG group was significantly lower (80.0% vs. 50.5%, P=0.01). Multivariate Cox regression analysis further confirmed that the presence of mixed low-grade components was an independent protective factor for recurrence free survival (HR=0.42, P=0.02), and other risk factors included T1 stage (HR=2.09, P=0.01). while tumor size was not associated with recurrence free survival. Conclusion: Coexistence of low-grade component in pathological specimen was associated with lower recurrence rate in patients with primary, solitary high-grade non-muscle invasive bladder cancer. Thus, it should be considered as a favorable pathological feature in bladder cancer patients.

Key words: Non-muscle invasive bladder cancer (NMIBC), High-grade, Coexistence, Low-grade, Prognosis

CLC Number: 

  • R737.14

Table 1

Baseline characteristics of the whole cohort"

Variable mHG (n=35) pHG (n=132) P
Age/years 0.58
  ≤65 12 52
  ＞65 23 80
Gender 0.86
  Male 27 100
  Female 8 32
Smoking status 0.66
  Never 27 97
  Former/current 8 35
UTUC history 0.18
  Yes 0 8
  No 35 124
Hypertension 0.59
  No 20 82
  Yes 15 50
Diabetes mellitus 0.46
  No 30 106
  Yes 5 26
Tumor size/cm 0.34
  ≤3 32 126
  ＞3 3 6
Pathological stage 0.13
  Ta 32 112
  T1 3 20
Median instillation numbers 15 16 0.54
Recurrence 0.01
  No 28 76
  Yes 7 56

Figure 1

Kaplan-Meier curve of RFS in the two groups mHG, mixed high grade; pHG, pure high grade."

Table 2

Univariable and multivariable Cox regression analysis"

Variables Univariate Multivariate
HR P HR P
Age/years 0.10
  ≤65 Reference
  ＞65 0.65 (0.39, 1.09)
Gender 0.64
  Male reference
  Female 1.08 (0.78, 1.51)
Smoking status 0.51
  Never reference
  Former/current 0.81 (0.44, 1.49)
Hypertension 0.88
  No reference
  Yes 0.96 (0.56, 1.64)
Diabetes mellitus 0.64
  No reference
  Yes 0.84 (0.41, 1.73)
Tumor size/cm 0.58
  ≤3 reference
  ＞3 0.67 (0.16, 2.82)
Stage 0.02 0.01
  Ta reference reference
  T1 2.02 (1.07, 3.81) 2.09
Pathology 0.03 0.02
  mHG 0.52 (0.19, 0.94) 0.52
  pHG reference reference
UTUC history 0.59
  No reference
  Yes 1.32 (0.46, 1.75)
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