Predicting non-muscle invasive bladder cancer recurrence and progression in a US population

To assess performance of The European Organization for Research and Treatment of Cancer (EORTC) and Club Urologico Español de Tratamiento Oncologico (CUETO) non-muscle invasive bladder cancer (NMIBC) predictive models compared to current US National Comprehensive Cancer Network (NCCN) treatment guidelines in a US population.

Retrospective analysis using electronic medical records of patients with NMIBC within a multicenter US patient population. We evaluated recurrence-free survival and progression-free survival according to EORTC and CUETO, and assessed discriminative performance with concordance index (c-index) at one and five years. We then compared the discrimination of EORTC and CUETO to the discrimination of the four NMIBC treatment groups described in NCCN guidelines.

We identified 1333 patients with NMIBC and a median follow-up of 37months. At five years, the c-indices of EORTC and CUETO for recurrence were 0.59 and 0.56, respectively, while for progression they were higher at 0.74 and 0.72, respectively. NCCN guidelines demonstrated similar c-indices of 0.56 and 0.75, respectively. The discrimination of all three risk models diminished in patients receiving bacillus Calmette-Guerin (BCG). EORTC was better able to identify patients at low risk of recurrence or progression but overestimated five-year risk of progression in high-risk patients. This study is limited by its retrospective design.

This work illustrates the need for improved predicative tools for clinicians treating NMIBC patients. However, until new tools are developed, NCCN guidelines are a simple option for clinicians treating NMIBC patients that provide comparable predictive power to the EORTC and CUETO models.

The Journal of urology. 2017 Apr 19 [Epub ahead of print]

Kourosh Ravvaz, Marcus E Walz, 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; University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA.