Dynamic prognostication using conditional recurrence and progression estimates for patients with non-muscle invasive bladder cancer

PURPOSE - Conditional estimates provide a dynamic prediction of outcomes, but there are no data for non-muscle invasive bladder cancer (NMIBC). The purpose of this study was to assess the changes in conditional recurrence and progression rates after transurethral resection of the bladder (TURB) and to explore the prognostic impact of established factors and risk groups over time.

METHODS - We retrospectively analyzed data from 1292 consecutive patients with a newly diagnosed Ta/T1 BC who underwent a TURB. The endpoints of this study were time to first recurrence and time to progression.

RESULTS - The 2-year recurrence rate at baseline was 36% and improved as a function of time that the patient had been free of disease recurrence. After 6-, 12-, 24-, 36-, and 48-months, the 2-year conditional recurrence rate improved to 31% (14% improvement compared with baseline), 22% (39%), 16% (56%), 13% (64%), and 11% (69%), respectively. Comparably, conditional progression rates improved with increasing follow-up, although relative differences were less distinct. The prognostic impact of established factors and the NMIBC risk group progressively decreased over time and finally disappeared. BCG, however, had a protective effect on progression even after 3 years. We also provide tables with dynamic prognostic information at all analyzed time points.

CONCLUSIONS - In patients with primary Ta/T1 BC, recurrence and progression rates improve over time. The prognostic impact of established factors and risk groups decreases and finally disappears. The effect of BCG on progression is long-lasting. Conditional outcome estimates may improve patient counseling and individualize surveillance planning.

The Journal of urology. 2016 Jan 30 [Epub ahead of print]

Carmen V Leitner, Ines A Ederer, Michela de Martino, Sebastian L Hofbauer, Ilaria Lucca, Aurélie Mbeutcha, Romain Mathieu, Andrea Haitel, Martin Susani, Shahrokh F Shariat, Tobias Klatte

Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 

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