Predicting recurrence and progression in patients with non-muscle-invasive bladder cancer : utility of the EORTC and CUETO scoring models
The goal of our study was to distinguish putative important predictive factors and to evaluate the utility of EORTC and CUETO existing models in patients with non-muscle-invasive bladder cancer (NMIBC). A retrospective single center study was performed including treated patients with NMIBC between January 2003 and December 2011 at our department. The following clinical and pathologic data were analyzed: gender, age, prior recurrence rate, number of tumors, tumor size, location of tumors, tumor stage, tumor grade, presence of CIS, second TURB, second TUR pathology, intravesical treatment, recurrence and progression of bladder tumor. Patients were stratified into three risk categories according to the EAU guidelines. Of the 611 patients, 197 (32%), 251 (41%) and 163 (27%) were assigned to the low, intermediate, and high risk category, respectively. Of these patients 535 (87.6%) underwent a second TUR. Overall, 528 patients were included ultimately in our follow-up study. The median follow-up was 60 months (range: 1-143 months). The overall recurrence rates was 18.6%, 33.7%, and 43.9% after the 1st, 2nd and 5th year, respectively. The corresponding progression rates were 0.9%, 2.6%, and 6.6%. Overall, prior recurrence rate and second TUR pathology are independent predictors of disease recurrence, whereas age, prior recurrence rate, tumor stage, tumor grade, second TUR, and second TUR pathology are prognostic factors for disease progression. The CUETO recurrence risk table severely underestimates the risk of disease recurrence in our cohort. However, the EORTC and CUETO risk tables are suitable tools to estimate disease progression in our cohort. Second TUR is of paramount importance and should be applied to all NMIBC patients. The EORTC and CUETO risk models are suitable to estimate progression risk. However, both risk calculators do not accurately predict risk of recurrence. The latter may be due to the routine use of second TUR in our cohort.
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