The aim of this study is to establish new risk tables for the current clinical setting, enabling short- and long-term risk stratification for recurrence, progression, and cancer-specific death after transurethral resection in non-muscle invasive bladder cancer (NMIBC). Currently available risk tables lack input from the 2004 World Health Organization grading system and risk prediction for cancer-specific death.
This was a multi-institutional database study of 1490 patients diagnosed with NMIBC (the development cohort). A multivariate Fine and Gray subdistribution hazard model was used to assess the prognostic impact of various factors. Patients were classified into low-, intermediate-, and high-risk groups according to a sum of the weight of selected factors, and predicted cumulative rates were calculated. Internal validation was conducted using 200 bootstrap resamples to assess the optimism for the c-index and estimate a bias-corrected c-index. External validation of the developed risk table was performed on an independent dataset of 91 patients.
The Japanese NIshinihon uro-onCology Extensive collaboration group (J-NICE) risk stratification table was derived from six, five, and two factors for recurrence, progression, and cancer-specific death, respectively. The internal validation bias-corrected c-index values were 0.619, 0.621, and 0.705, respectively. The application of the J-NICE table to an external dataset resulted in c-indices for recurrence, progression, and cancer-specific death of 0.527, 0.691, and 0.603, respectively.
We propose a novel risk stratification model that predicts outcomes of treated NMIBC and may overcome the shortcomings of existing risk models. Further external validation is required to strengthen its clinical impact.
International journal of clinical oncology. 2020 Mar 30 [Epub ahead of print]
Makito Miyake, Hideyasu Matsuyama, Satoshi Teramukai, Fumie Kinoshita, Isao Yokota, Hiroaki Matsumoto, Keiji Shimada, Mitsuru Kinjyo, Tatsuro Shimokama, Koji Okumura, Masaya Yomenori, Hideki Enokida, Masayuki Nakagawa, Yasushi Nakai, Kiyohide Fujimoto, Nishinihon Uro-oncology Extensive Collaboration group
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan., Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, 755-8505, Japan., Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan., Department of Biostatistics, Graduate of Medicine, Hokkaido University, Kita15 Nishi7, Kita-ku, Sapporo, 060-8638, Japan., Department of Pathology, Nara City Hospital, 1501 Higashi kidera-cho, Nara-shi, Nara, 630-8305, Japan., Department of Pathology, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu-shi, Fukuoka, 805-0050, Japan., Department of Urology, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu-shi, Fukuoka, 805-0050, Japan., Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan., Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. .