To apply non-muscle invasive bladder cancer (NMIBC) AUA/SUO guidelines for risk-stratification and analyze predictors of recurrence and progression.
Retrospective review of 398 patients with NMIBC treated between 2001 and 2017. Descriptive statistics were used to compare AUA/SUO risk-groups. Predictors of recurrence and progression were determined by multivariable regression. Kaplan Meier analysis, Cox proportional hazards regression model and time-dependent AUC was performed to determine progression-free and recurrence-free survival by risk-group.
Median follow-up was 37-months (95% CI: 35- to 42-months). 92% of patients underwent BCG induction and 46% of patients received at least 1 course of maintenance treatment. There were 11.5% low-risk, 32.5% intermediate-risk and 55.8% high-risk patients. The 5-year progression-free survival (PFS) and recurrence-free survival (RFS) for low-, intermediate- and high-risk patients was 93%, 74% and 54% and 43%, 33% and 23%, respectively. On Kaplan Meier analysis, HG Ta ≤3cm RFS and PFS stratified between intermediate and high-risk group. Relative to low-risk, classification as intermediate- or high-risk was an independent predictor of progression (HR: 9.7, CI: 2.23-42.0, p<0.01 and HR: 36, CI: 8.16-159, p<0.001, respectively). High-risk patients were more likely to recur relative to low-risk patients (HR: 2.03, CI: 1.11-3.71, p=0.022). For recurrence and progression, 1 year AUC values were 0.60 (CI: 0.546-0.656) and 0.68 (CI: 0.622-0.732), respectively.
The AUA/SUO NMIBC risk-classification system appropriately stratifies patients based on likelihood of recurrence and progression and should be used at the time of diagnosis to counsel patients and guide therapy.
The Journal of urology. 2019 Oct 14 [Epub ahead of print]
Chad R Ritch, Maria C Velasquez, Deukwoo Kwon, Maria F Becerra, Nachiketh Soodana-Prakash, Venkatasai S Atluri, Katherine Almengo, Mahmoud Alameddine, Omer Kineish, Bruce R Kava, Sanoj Punnen, Dipen J Parekh, Mark L Gonzalgo
Department of Urology, University of Miami Miller School, Miami, Florida., Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.