(UroToday.com) The 2024 European Association of Urology (EAU) annual meeting featured a non-muscle invasive bladder cancer session and a presentation by Dr. Giulio Avesani discussing a comparison of the EAU and International Bladder Cancer Group (IBCG) criteria for intermediate-risk non-muscle invasive bladder cancer. The EAU and the IBCG present different definitions of intermediate risk non-muscle invasive bladder cancer. This study, presented at EAU 2024, aims to compare the long-term outcomes of intermediate risk patients according to the two classifications.
Dr. Avesani and colleagues conducted an analysis of 430 non-muscle invasive bladder cancer patients who underwent transurethral resection of bladder tumor (TURBT) + BCG (optimal BCG: 1 year of maintenance) at a tertiary referral center between 2010 and 2020. EAU intermediate risk classification includes non-low and -high risk patients, including pTa high grade patients. IBCG intermediate risk classification excludes any type of high grade tumor. Risk of recurrence and progression was assessed through cumulative incidence curves, stratified for both groups. Additionally, multivariable Cox-regression analysis was used to assess predictors of recurrence and progression within the overall intermediate risk group (covariates included age, grade, T stage, size, multifocality, and adequate treatment (≥ 12 maintenance instillations over 1 year)).
In total, 199 and 83 patients were classified as having intermediate risk disease according to EAU and IBCG classification, respectively:
During a median follow-up of 48 (IQR 32-60) months, 92 recurrence events and 29 progression events were recorded. Adequate BCG treatment was administered to 114 (57%) and 41 (50%) patients in the EAU and IBCG groups. No statistically significant difference emerged between intermediate risk-IBCG and intermediate risk-EAU groups in terms of cumulative risk of recurrence at 40 months (30% vs 32%, p = 0.4):
When considering patients who received adequate BCG treatment, the risk of progression at 40 months was higher in the intermediate risk-EAU compared to intermediate risk-IBCG group (10% vs. 5%, p = 0.03):
On multivariable Cox-regression analysis, high grade/G3 histology (HR 2.54, CI 1.15-5.59, p = 0.021) and tumor size ≥ 3 cm (HR 2.49 CI 1.31-4.74, p = 0.005) were independent predictors of recurrence in the EAU group, while no predictors of recurrence were observed in the intermediate risk-IBCG group:
Dr. Avesani concluded his presentation discussing a comparison of the EAU and IBCG criteria for intermediate-risk non-muscle invasive bladder cancer with the following conclusions:
- Patients with intermediate risk according to IBCG criteria show better oncological outcomes, especially in terms of progression compared to the equivalent EAU class
- Better patient stratification should be achieved, especially for those patients with high grade/G3 disease or tumor size ≥ 3 cm
- The presence of high grade/G3 tumors and tumor size ≥ 3 may be associated to an increased risk of progression, highlighting the need for their consideration as exclusion criteria for intermediate risk disease definition
Presented by: Giulio Avesani, IRCCS Ospedale San Raffaele Vita-Salute San Raffaele University, Milan, Italy
Written by: Zachary Klaassen, MD, MSc - Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, WellStar MCG Health, @zklaassen_md on Twitter during the 2024 European Association of Urology (EAU) annual congress, Paris, France, April 5th - April 8th, 2024