This pooled analysis of individual patient data from four RCTs (HIVEC-II, PHOTO, BOXIT, CALIBER) examined oncological outcomes and optimal cystoscopy surveillance intervals in 578 patients with intermediate-risk NMIBC who underwent complete tumor resection followed by 6 weekly intravesical mitomycin C instillations, with a median follow-up of 34 months.
Recurrence-free rates were 73%, 61%, 56%, and 54% at 12, 24, 36, and 60 months, with no meaningful rise after 36 months; noncumulative recurrence risk fell to <5% by 60 months. Grade/stage progression was rare (<5%), and cancer-specific survival was 99% at 60 months. Independent predictors of recurrence were prior recurrence (HR 1.75), multifocality (HR 1.49), and higher grade (HR 1.57).
- Pooled data from four trials not originally designed to address surveillance frequency, introducing potential heterogeneity. - Median follow-up of only 34 months limits confidence in the 60-month estimates. - All patients received mitomycin C; findings may not generalize to other adjuvant regimens.
For IR-NMIBC patients treated with mitomycin C, the highest recurrence burden occurs within the first 36 months — focus surveillance intensity there. After 60 months, noncumulative recurrence risk drops below 5%, supporting a reduction or cessation of routine cystoscopy in this group.
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