Validation of EORTC, CUETO, and EAU risk stratification in prediction of recurrence, progression, and death of patients with initially non–muscle‐invasive bladder cancer (NMIBC): A cohort analysis

• Published in: Cancer medicine (Malden, MA) Vol. 9; no. 11; pp. 4014 - 4025
• Main Authors: Jobczyk, Mateusz, Stawiski, Konrad, Fendler, Wojciech, Różański, Waldemar
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2020; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Algorithms; Bacillus Calmette-Guerin vaccine; BCG; Bladder cancer; Cancer; Cancer Prevention; Cancer therapies; Chemotherapy; Cohort analysis; Cystectomy - mortality; Disease Progression; Female; Follow-Up Studies; Humans; Immunotherapy; Invasiveness; Male; Medical prognosis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; non–muscle‐invasive bladder cancer; Original Research; Patients; Practice Guidelines as Topic - standards; prediction; Predictions; Prognosis; Retrospective Studies; Risk Assessment - methods; Risk Assessment - standards; Risk Factors; Risk groups; risk stratification; Studies; Survival analysis; Survival Rate; Systematic review; Tumors; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; prediction; risk stratification; systematic review; bladder cancer; non-muscle-invasive bladder cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3007

Brief Description: The results demonstrate that the European Organisation for Research and Treatment of Cancer (EORTC) scale provides the best recurrence and progression prediction in comparison with European Association of Urology (EAU) and Club Urologico Espanol de Tratamiento Oncologico (CUETO) risk scores among a mixed population of patients with non–muscle‐invasive bladder who were treated with, or without, Bacillus Calmette‐Guerin (BCG) and without any immediate postoperative chemotherapy. The study highlights the role of tumor diameter and extent in transition prediction. This retrospective cohort analysis of 322 patients with newly diagnosed non–muscle‐invasive bladder cancer (NMIBC) assesses the concordance and accuracy of predicting recurrence and progression by EAU‐recommended tools (EAU risk groups, EORTC, and CUETO). One‐year and five‐year c‐indices ranged from 0.55 to 0.66 for recurrence and from 0.72 to 0.82 for progression. AUCROC of predictions ranged from 0.46 for 1‐year recurrence risk based on CUETO groups, to 0.82 for 1‐year progression risk based on EAU risk groups. Diameter (HR: 1.91; 95% CI: 1.39‐2.61) and tumor extent (HR: 1.21; 95% CI: 1.01‐1.46 for recurrence; HR: 3.1; 95% CI: 1.40‐6.87 for progression) were shown to be significant predictors in multistate analysis. Lower accuracy of prediction was observed for patients treated with BCG maintenance immunotherapy. The EORTC model (overall c‐index c = 0.64; 95% CI: 0.61‐0.68) was superior to the EAU (P = .035; .62; 95% CI: 0.59‐0.66) and CUETO (P < .001; c = 0.53; 95% CI: 0.50‐0.56) models in predicting recurrence. The EORTC model (c = 0.82; 95% CI: 0.77‐0.86) also performed better than CUETO (P = .008; c = 0.73; 95% CI: 0.66‐0.81) but there was no sufficient evidence that it performed better than EAU (P = .572; c = 0.81; 95% CI: 0.77‐0.84) for predicting progression. EORTC and CUETO gave similar predictions for progression in BCG‐treated EAU high‐risk patients (P = .48). We share anonymized individual patient data. In conclusion, despite moderate accuracy, EORTC provided the best recurrence and progression prediction for a mixed population of patients treated with, or without BCG, and without immediate postoperative chemotherapy. For mixed population of patients with non–muscle‐invasive bladder who were treated with and without Bacillus Calmette‐Guerin and without any immediate postoperative chemotherapy, we show that European Organisation for Research and Treatment of Cancer scale provides the best recurrence and progression prediction in comparison with European Association of Urology and Club Urologico Espanol de Tratamiento Oncologico risk scores. We highlight the role of diameter and tumor extent in transition prediction.