Recurrence Risk Prediction Nomogram for Non-muscle Invasive Bladder Cancer Patients - Expert Commentary

Non-muscle invasive bladder cancers (NMIBC) represent the majority of new bladder cancer diagnoses. A high recurrence rate characterizes the natural history of the disease. Understanding the risk factors for recurrence is critical for predicting the individual recurrence risk of recurrence. 

A new study published by Lu et al. introduced a prediction model based on recurrence risk factors to identify NMIBC patients with a high risk of relapse. The researchers included 477 patients (392 males and 85 females) who were recently diagnosed with primary NMIBC (Ta-T1) between January 2012 and December 2016. All patients underwent transurethral resection of bladder tumor. The researchers found that recurrences occurred in 68.6% (327) of the patients. Multivariate analysis showed that smoking history (HR: 1.124; 95% CI: 1.102–1.674; P=.044), large size of tumor (HR: 2.627; 95% CI: 1.510–4.085; P=.018), multifocal tumors (HR: 2.048; 95% CI: 1.661–4.276; P=.010), high grade (HR: 3.253; 95% CI: 2.215–6.488; P<.001), and high stage (HR: 3.132; 95% CI: 2.002–5.614; P=.002) were independent risk factors for NMIBC recurrence.

The authors then established a nomogram based on Cox regression analyses to calculate the probability of each NMIBC recurrence (within two years of diagnosis). The nomogram included several risk factors, including tumor size, smoking history, multifocality, immediate infusion therapy, tumor stage, and grade. Calibration curves demonstrated agreement of the predicted probability with the actual rates of NMIBC recurrence.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

Reference: 
Lu M, Chen S, Zhou Q, Wang L, Peng T, Wang G. Predicting recurrence of nonmuscle-invasive bladder cancer (Ta-T1): A study based on 477 patients. Medicine (Baltimore). 2019 Jul;98(28):e16426. doi: 10.1097/MD.0000000000016426. PMID: 31305463
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