Norwegian Bladder and Urothelial Cancer Registry
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The incidence of bladder cancer is significantly higher for men than for women. The goal is for the quality of investigation and treatment of bladder and urothelial cancer to improve, and for patients to receive equitable healthcare.
Summary from the annual report 2024
Results
The National Clinical Registry for Bladder and Urothelial Cancer received national approval in 2024 and has prepared an annual report based on generic data from the Cancer Registry’s basic register. The annual report contains, like the first report, analyses of figures of a more descriptive nature, as the data are currently limited. Development of separate bladder and urothelial cancer-specific forms will, in the long term, provide an even more detailed description of the assessment and treatment of bladder and urothelial cancer and compliance with the National Treatment Guidelines.
Bladder and urothelial cancer were the sixth most common cancer among men in Norway in 2023. Bladder and urethral cancer account for the largest proportion of patients diagnosed with bladder and urothelial cancer. The incidence rate is significantly higher for men than for women. In the period 1990–2024, the incidence of renal pelvis and ureteral cancer has remained relatively stable for both sexes. The incidence is somewhat higher for men than for women in the same period.
Most bladder cancer patients have tumours with relatively good prognosis. The annual report shows that nationally, 17 % have muscle-invasive bladder cancer (MIBC) at the time of diagnosis, requiring radical treatment. Half of the patients with non-muscle-invasive bladder cancer (NMIBC) develop new tumours after the first tumour is removed.
This requires a lot of resources in the specialist health service and can be a burden for the patients.
For patients receiving curative surgical treatment within three months of TURB with stage pT1, reTURB accounts for the largest proportion (60 %). 11 % receive both reTURB and cystectomy/cystoprostatectomy, while very few patients go directly to radical surgery.
The use of neoadjuvant chemotherapy before cystectomy/cystoprostatectomy for bladder cancer patients has good evidence. Among the regional health authorities, the use of MVAC and GC varies widely. Helse Nord does not currently have a digital system for drug treatment available and cannot therefore be compared with the other regional health authorities. According to the National Treatment Guidelines for Bladder and Urothelial Cancer, cisplatin-based chemotherapy is recommended. MVAC is the preferred regimen as this combination has the best documentation.
The distribution of pathological stage (pT) in cystectomy/cystoprostatectomy histology specimens shows that approximately 80 % of the patients still have cancer in the bladder. 45 % have muscle-invasive bladder cancer. The absence of cancer in the specimen is due either to the cancer being removed by TURB, or to neoadjuvant chemotherapy having removed the remaining tumour tissue after TURB. Patients without proven cancer in the tissue have a favourable prognosis. Information from impending clinical reports will be able to provide a better analysis of this.
Use of adjuvant nivolumab for radically operated bladder cancer patients - with muscle-invasive urothelial carcinoma with PD-L1 expression ≥ 1 % and with high risk of recurrence - was approved by Beslutningsforum for nye metoder on 28.08.23. Few patients are offered this treatment. Nationwide, 28 % of radically operated patients, in the high-risk group, have received adjuvant nivolumab within four months after surgery.
The probability of dying from bladder cancer is more likely than the probability of dying from other cancers or other causes for patients with tumours stage pT ≥ 2.The high mortality rate at pT1 may be due to muscle infiltration before neoadjuvant chemotherapy, and that 10-15 % already have cancer in the lymph nodes at diagnosis.
5-year relative survival for women (38,9 %) and men (53,3 %), for all ages and stages of muscle-invasive bladder cancer, shows both the severity of the disease, but that a gender difference also exists. 5-year relative survival for cystectomised/cystoprostatectomised patients of both sexes is significantly higher (74,1 % (adjusted for age) and 72,3 % (adjusted for age and pT)).
Data quality
One of the main goals of this report has been to assess the quality of the data and the basis of the data. Various analyses show, in some cases, great differences between the different regions in the treatment codes recorded in the Norwegian Patient Registry. The Advisory Board and the Cancer Registry will work together to achieve uniform coding practices in all of the regional health authorities, in order to improve the data quality in this area.
The interrater reliability study, which was conducted on the basis of coded variables in the General Pathology form, show that the degree of agreement is generally very high, but that the agreement in coding of some variables can be even higher.