Abstract
OBJECTIVE: This review aims to explore the risk factors for recurrence of non-muscle-invasive bladder cancer (NMIBC) and evaluate current prevention strategies to provide valuable insights for future clinical management. By systematically analyzing various clinical and pathological characteristics, this review examines their relationship with NMIBC recurrence and proposes effective preventive measures for these factors. METHODS: A systematic literature search was conducted through PubMed and Web of Science to identify studies that focus on the risk factors for NMIBC recurrence. A systematic review was conducted to evaluate the statistical significance of various factors influencing recurrence, such as age, sex, body mass index (BMI), diabetes, smoking, surgical techniques, and tumor-specific characteristics. Additionally, current preventive strategies and treatments, such as intravesical drug instillation, adjuvant chemotherapy, and immunotherapy, were assessed. RESULTS: The following factors significantly influence the recurrence risk of NMIBC: age (older patients have a higher recurrence risk due to weakened immune responses and more comorbidities), sex (women tend to experience more aggressive forms and a poorer prognosis following recurrence), BMI and diabetes (obesity and diabetes worsen immune responses and increase inflammation, contributing to higher recurrence rates), smoking (smokers face a higher recurrence risk due to carcinogenic exposure, but quitting significantly reduces the risk), surgical techniques (incomplete transurethral resection of bladder tumor or inadequate postoperative treatments, e.g., Bacillus Calmette-Guérin [BCG], increase recurrence), tumor characteristics (high-grade and large tumors [especially multifocal] have a higher risk of recurrence), immunotherapy and chemotherapy (BCG is standard for high-risk patients, while newer treatments, such as immune checkpoint inhibitors [e.g., pembrolizumab] and chemotherapy [e.g., gemcitabine with docetaxel], are emerging for BCG-unresponsive cases), and biomarkers (biomarkers like tumor DNA in urine or circulating tumor DNA in blood can facilitate early detection of recurrence and help predict recurrence risk). CONCLUSION: NMIBC recurrence is a complex process influenced by multiple factors. Identifying the risk factors associated with recurrence, such as age, sex, BMI, diabetes, smoking, and surgical techniques, allows for personalized treatment strategies. BCG treatment remains the standard for preventing recurrence, but new immunotherapies and chemotherapy combinations provide hope for BCG-unresponsive patients. Early detection, effective postoperative treatment, and individualized management strategies are key to reducing recurrence and improving patient quality of life. Future research should continue exploring new treatment methods, molecular biomarkers, and the role of immunotherapy in mitigating NMIBC recurrence.