American Urological Association Non-muscle Invasive Bladder Cancer Risk Model Validation: Should patient age be added to the risk model?

To evaluate the American Urological Association (AUA)/Society of Urologic Oncology (SUO) non-muscle invasive bladder cancer (NMIBC) risk model to predict NMIBC recurrence and progression prior to death.

Retrospective analysis using electronic medical records and cancer registry data of patients with NMIBC within a multicenter U.S.

We evaluated recurrence-free survival and progression-free survival according to the AUA/SUO NMIBC risk model. Then we assessed discriminative performance with concordance index (c-index). We then compared the cumulative incidence of recurrence, progression and death across four age groups.

We identified 1,297 patients with NMIBC. Median follow-up for the cohort was 3.2 years. The c-indices of the AUA/SUO model for recurrence were 0.62, while for progression they were higher at 0.77. Patients <60 years old have a 40% greater probability of NMIBC recurrence versus death, whereas, patients ≥84 years old had a 12% greater probability of death prior to recurrence at five years. This study is limited by its retrospective design.

The AUA/SUO NMIBC risk model provides similar predictive performance of recurrence and progression to previous NMIBC risk models such as EORTC, CUETO and NCCN. This work illustrates the need for considering age within predictive tools for clinicians treating patients with NMIBC.

The Journal of urology. 2019 Jun 12 [Epub ahead of print]

Kourosh Ravvaz, John A Weissert, Tracy M Downs

Aurora Research Institute, Aurora Health Care , Milwaukee , WI , USA., Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison , WI , USA.