What are the factors for recurrence of superficial bladder cancer?

Superficial bladder cancer refers to all tumors from TaG1 to T1G3, including Tis carcinoma in situ. About 75% to 85% of new bladder cancers are superficial bladder cancers. Without further treatment, about 70% of cases are likely to recur. The cause of recurrence of superficial bladder cancer is still controversial, but its recurrence is closely related to a variety of factors. Analyzing and studying the use and significance of these factors in bladder cancer recurrence is helpful for early diagnosis, timely and effective treatment, and long-term prognosis estimation. The following experts will explain the research progress on the causes of recurrence of superficial bladder cancer and various factors.

1. Multicentric growth of bladder cancer: The multicentricity of bladder transitional epithelium has been frequently reported recently. Andres believes that bladder cancer patients often present with multicentric tumors from the onset. The simultaneous growth of several tumors also suggests that these tumors will tend to be chronic, that is, her recurrence probability is more than 3 times that of a single tumor. Whether the tumor is multicentric has also become one of the most important indicators for judging the risk of tumor recurrence. The multicentricity of superficial bladder cancer is generally attributed to the implantation of desquamated epithelium and the instability of the entire bladder epithelium to carcinogenic factors. The following describes them one by one.

(1) Instability of transitional epithelium in bladder cancer: It has been proven that there are genetic defects and chromosomal abnormalities in the evolution of transitional epithelium in bladder mucosa. Experiments show that 93.6% of patients with recurrent bladder cancer have changes in the 7th pair of chromosomes, while 63.8% and 87.2% of patients have changes in the 9th and 17th pairs of chromosomes, respectively. Compared with the control group, the aberration rate is significantly increased. Abnormal changes in chromosomes cause a decrease in normal expression products and an increase in abnormal expression products. For example, the expression of MHC-1 and 2 molecules on the surface of the tumor is lost and weakened. The aberration on chromosome 17 causes the aberration of wild-type p53 expression, which greatly increases the recurrence rate. Okmuru tested the apoptosis gene Bcl-2 in 19 patients and found that the positive rate in the recurrence group was 36.8%, while that in the initial group was as high as 78.9%. Recently, droller found that telomerase is also related to the recurrence of bladder cancer.

(2) Implantation theory: Takahashi's research shows that the cells of upper urinary tract tumors and bladder tumor recurrences originate from the same starting cells. This proves the implantation theory to a certain extent. As early as 1987, Pode simulated the adhesion process of tumor cells and matrix in vitro, and pointed out through experiments that stopping tumor cell adhesion and implantation by immediate postoperative infusion of chemotherapy drugs can effectively prevent the recurrence of bladder cancer. In patients who undergo postoperative bladder reconstruction, bladder cancer recurrence is still an important factor affecting prognosis, among which implantation at the resection margin may be a very important reason.

2. The special environment of the bladder: The urine environment contains carcinogens such as BBN (N-butyl-N-4-hydroxybutylnitrosamine), and the transitional epithelium of the bladder mucosa is obviously sensitive to these carcinogens. This is not only an important cause of bladder cancer, but also one of the reasons for postoperative recurrence. The current treatment method, which is mainly surgical treatment, supplemented by chemotherapy and radiotherapy, obviously cannot change the carcinogenic nature of urine. Therefore, it is difficult to avoid the recurrence of bladder cancer in the current bladder preservation surgery. People with prostatic hypertrophy are prone to bladder cancer due to urine retention, and relieving obstruction can reduce the risk of bladder cancer recurrence.

3. Immune deficiency: Bladder cancer patients have obvious immune function suppression and deficiency, which is manifested by decreased number of peripheral blood total T, T1, NK, macrophages, increased CD8 cells, decreased CD4/CD8 ratio, lymphocyte softening, stimulation index, NK cell activity and IL-2 induction level lower than the normal group. Therefore, by infusing BCG (BCG), local immune response can be induced, or interferon (IFN) can be directly injected locally to enhance immune response, which can effectively prevent the recurrence of bladder cancer.

4. Defects in surgical methods: For superficial bladder cancer, whether it is open surgery or transurethral resection (TUR), it may cause residual tumors or surgical implants due to unclear identification or unfamiliar operation, leading to early recurrence. Some tumors located in special locations may also lead to incomplete resection due to difficult operation. For example, bladder cancer located in the triangular area is located in the submucosal layer, close to urination and the ureteral opening, so the resection depth or range is insufficient, resulting in residual tumors and early recurrence after surgery. Erckert et al. analyzed the causes of recurrence in 910 patients with bladder cancer and found that among all the influencing factors, tumors located in the cervical opening, triangular area and posterior urethra are much more likely to recur than tumors in other locations, and are one of the most important factors affecting recurrence in the near future. This may be related to the anatomical structure of these structural locations, which are difficult to operate.

The above is an introduction to the causes of recurrence of superficial bladder cancer. Expert Tips: If you have symptoms of disease in your health, you can choose the appropriate treatment according to your symptoms, but do not delay diagnosis, and do not let your life be ruined by hesitation. You should go to a regular hospital for medical treatment in time to avoid delaying the disease and causing serious consequences. If you have other questions, please consult our online experts or call for consultation. Believe in miracles, and wish you health, happiness, and joy!

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