To evaluate the validation of European Organization for Research and Treatment of Cancer (EORTC) risk tables to predict progression in Brazilian patients with non-muscle-invasive bladder cancer (NMIBC).
Two hundred five consecutively and prospectively selected patients with NMIBC who underwent transurethral resection were analyzed during 12 years. Six parameters were analyzed: tumor grade, size, and number, pT stage, previous recurrence rate, and carcinoma-in-situ. Time to progression, risk score, and progression probabilities were calculated and compared to probabilities obtained from the EORTC model. The C index was calculated, and accuracy was analyzed for external validation.
A total of 152 patients had complete follow-up data, 36 died, and 17 were lost to follow-up. One hundred thirty-seven patients had primary tumors and 68 had recurrent tumors. Progression to muscle-invasive disease occurred in 42 patients (20. 5%). Significant characteristics related to progression were male gender, pT1 stage, lesion size ≥ 3 cm, high grade of disease, and no combined intravesical therapy. Mean time to progression was 26. 9 months; the 1-year progression rate was 3. 4% and the 5-year rate was 19. 1%. The C index was 0. 86 at 1 year and 0. 78 at 5 years. For calibration, 1- and 5-year progression rates were lower than the values predicted by EORTC risk tables, mainly in high-risk groups. Although the EORTC model overestimated the short- and long-term risk of progression, an overlapping of the confidence intervals between both populations was detected.
The EORTC model successfully stratified progression risks in a Brazilian cohort, although it overestimated progression rates. This scoring system is useful in predicting progression of NMIBC; however, updating new risk markers is essential to improve risk classification and prediction of progression.
Clinical genitourinary cancer. 2015 Sep 25 [Epub ahead of print]
Wilson F S Busato Júnior, Gilberto Laurino Almeida, Carmen A P M Ribas, Jurandir M Ribas Filho, Ottavio De Cobelli
University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil. , University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil; Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil. Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil. , Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil. , University of Milan, Milan, Italy; Department of Urology, European Institute of Oncology (IEO), Milan, Italy.