The EORTC tables overestimate the risk of recurrence and progression in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: external validation of the EORTC risk tables

Abstract

Background: European Organization for Research and Treatment of Cancer (EORTC) risk tables only included 171 patients treated with bacillus Calmette-Guérin (BCG) for non-muscle-invasive bladder cancer (NMIBC).

Prediction tools in non-muscle invasive bladder cancer

“…Xylinas et al (5) evaluated their efficacy on 4,689 patients, founding that both risk tables overestimate disease recurrence and progression. Same result was reported by Fernandez-Gomez et al (6), who found that the EORTC score overestimates the risk of recurrence and progression in patients treated with BCG. Moreover, when the EORTC data have been applied to the CUETO model, an underestimation of the risk of recurrence in low-risk patients and an overestimation of the risk of progression in high risk patients have been found (7).…”

External validation of European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment scoring models to predict recurrence and progression in Japanese patients with non‐muscle invasive bladder cancer treated with bacillus Calmette–Guérin

“…[4][5][6][7][8][9] Among them, the CUETO group validated the EORTC table using a dataset from the CUETO scoring system. 7 Their results showed that the EORTC tables overestimated the risk of recurrence in all risk groups, as well as the probabilities of progression in higher-risk patients. This observation is consistent with the notion that BCG is superior to chemotherapy in terms of preventing recurrence and progression.…”

“…It is also consistent with observations from previous studies that the EORTC table overestimated the risk of recurrence and progression in high-risk patients undergoing BCG instillation therapy. 7 Considering that the EORTC model could stratify Chinese patients (where BCG instillation therapy was not available) to a better degree, 9,11 the patient cohort seems to be crucial to determining which scoring system is more applicable.…”

Chronic kidney disease as a risk factor for recurrence and progression in patients with primary non‐muscle‐invasive bladder cancer

“…However, each risk stratification model has its limitations, and there is a need for more accurate prediction. 17,18 Xylinas et al, for example, reported that the EORTC risk tables and the Spanish Urological Club for Oncological Treatment scoring models show poor discrimination for both recurrence and progression in NMIBC patients. 18 Previously, CKD, especially at stages higher than G3b (eGFR <45), has been shown in a retrospective cohort study of 1 190 538 adults to have a higher risk for urothelial carcinoma incidence.…”