This study aimed to identify prognostic factors that influence the recurrence, progression, and multiple recurrences of non-muscle-invasive bladder cancer (NMIBC) based on data from the Hualien Tzu Chi Hospital, Taiwan.

A retrospective cohort study enrolled patients with NMIBC diagnosed between 2005 and 2022 who underwent transurethral resection of bladder tumor (TUR-BT). Demographic, clinical, and pathological data, including age, sex, smoking status, alcohol consumption, betel nut use, history of upper urinary tract urothelial cancer, hypertension, diabetes mellitus, tumor count, T stage category, tumor grade, bacillus Calmette–Guérin (BCG) therapy, and recurrence outcomes, were collected. Cox proportional hazard regression models were used to analyze factors associated with recurrence, progression to muscle-invasive disease, and risk for multiple recurrences.

Overall, 202 patients were included, with a mean follow-up duration of 4.5 years. Tumors recurred in 53% of the patients, which further progressed to muscle-invasive bladder cancer in 12.9%. Multivariate Cox regression analysis identified betel nut chewing, multiple tumors, high-grade tumors, and lack of BCG therapy as significant predictors of recurrence. Age, high-grade tumors, and recurrence within 3 months after the initial TUR-BT were significant predictors of progression. Multiple tumors, high-grade tumors, and early recurrence occurring within 3 months after the initial TUR-BT were significantly associated with the risk of experiencing three or more recurrences.

This study highlights that betel nut chewing, multiple tumors, high-grade tumors, and BCG therapy significantly influence recurrence in patients with NMIBC. Age, tumor grade, and early recurrence are key predictors of progression to muscle-invasive bladder cancer. Multiple tumors, high-grade tumors, and early recurrence were significantly associated with the risk of experiencing three or more recurrences.