EORTC risk tables are more suitable for Chinese patients with nonmuscle-invasive bladder cancer than AUA risk stratification

Abstract

Background:Patients with non-muscle-invasive bladder cancer (NMIBC) need accurate estimations of the risk of recurrence and progression. Physicians can offer individualized therapy after identifying high-risk tumors. In our study, we compared the applicability of European Organization for Research and Treatment of Cancer (EORTC) risk tables and American Urological Association (AUA) risk stratification in Chinese patients with NMIBC.Methods:We retrospectively studied 301 patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) between October 2000 and July 2009 at Huashan Hospital of Fudan University and analyzed their parameters. The recurrence and progression rates at 1 and 5 years postoperatively were calculated along with 95% confidence intervals. We compared them with results obtained from the EORTC risk tables and AUA risk stratification. P values <.05 were considered statistically significant.Results:The median patient age was 67 years (21–92 years) and the median follow-up duration was 46 months (2–151 months). We used EORTC risk tables to classify patients into 3 groups, depending on whether they suffered recurrence or progression after TURBT. Kaplan–Meier curves showed significant differences among the 3 recurrence-free survival (RFS) levels (P < .0001, log-rank test) and among the 3 progression-free survival (PFS) levels (P < .0001, log-rank test). AUA risk stratification showed the same results. Both classifications were suitable to predict recurrence and progression in Chinese patients. However, for high-risk patients in both series, Kaplan–Meier curves showed significant differences between RFS levels (P < .0001, log-rank test) and between PFS levels (P < .0001, log-rank test). EORTC risk tables were stricter and AUA was more sensitive in assigning patients to a high-risk group.Conclusion:EORTC risk tables are better than AUA risk stratification for predicting recurrence and progression in Chinese patients with NMIBC, especially among high-risk patients.

Clinical Evaluation of Patients with Mixed Low-and-High Grade Non-muscle Invasive Bladder Cancer with EORTC Risk Scores

“…Kaplan-Meier curves showed signi cant differences among the 2 RFS (P = 0.0362 < 0.05, logrank test) and 3 PFS (P = 0.0077 < 0.01, log-rank test) levels separately, demonstrating that EORTC risk scores is predictive to tumor recurrence and prognosis of MG patients. These results are consistent with previous research by Wang et al (20), who reported that EORTC risk scores were better for predicting recurrence and progression in Chinese patients with NMIBC. The results of our study showed that the short-term recurrence rate of bladder cancer is basically consistent with the EORTC system.…”

Validation of EORTC, CUETO and EAU risk stratification in prediction of recurrence, progression and death of patients with initially non-muscle invasive bladder cancer (NMIBC): a cohort analysis with systematic review.

“…by Shen et al [15] Our systematic analysis has also shown the inconsistency in reporting the validity of utilized stratification approaches. For example, very recent analysis of 301 patients by Wang et al [16] or the analysis of 1436 patients by Rieken et al [17] (e.g. in the group without immediate postoperative instillation of chemotherapy) could not be included in the review due to lack of c-index or AUCROC analysis.…”

KEYNOTE-676: Phase III study of BCG and pembrolizumab for persistent/recurrent high-risk NMIBC

“…BCG is a live-attenuated strain of Mycobacterium bovis that induces an immune response in the bladder when administered [7]. Although approximately 70% of patients with NMIBC achieve complete response (CR) with BCG therapy, many patients with high-risk disease do not maintain remission [8][9][10][11][12][13]. As many as 60% of patients can have disease recurrence within 1 year, increasing to 80% within 15 years [9,13].…”

“…Although approximately 70% of patients with NMIBC achieve complete response (CR) with BCG therapy, many patients with high-risk disease do not maintain remission [8][9][10][11][12][13]. As many as 60% of patients can have disease recurrence within 1 year, increasing to 80% within 15 years [9,13]. In addition, within 5 years, up to approximately 20-40% of patients who experience BCG failure will also experience progression to muscle invasive disease [14][15][16][17] and approximately 6-15% of patients will have metastasis to the lymph nodes [18][19][20].…”