Towards Defining Follow-up Strategies for Patients with Primary Intermediate-risk Non-muscle-invasive Bladder Cancer.
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Contieri Roberto, Martini Alberto, Beijert Irene J, Mertens Laura S, Hentschel Anouk E, Bründl Johannes, Compérat Eva M, Plass Karin, Rodríguez Oscar, Subiela Henríquez Jose D, Hernández Virginia, de la Peña Enrique, Alemany Isabel, Turturica Diana, Pisano Francesca, Soria Francesco, Čapoun Otakar, Bauerová Lenka, Pešl Michael, Maxim Bruins H, Runneboom Willemien, Herdegen Sonja, Breyer Johannes, Brisuda Antonin, Calatrava Ana, Rubio-Briones José, Seles Maximilian, Mannweiler Sebastian, Bosschieter Judith, Kusuma Venkata R M, Ashabere David, Huebner Nicolai, Seisen Thomas, Claps Francesco, Masson-Lecomte Alexandra, Liedberg Fredrik, Cohen Daniel, Lunelli Luca, Cussenot Olivier, Sheikh Soha El, Volanis Dimitrios, Côté Jean-François, Rouprêt Morgan, Haitel Andrea, Shariat Shahrokh F, Mostafid A Hugh, Nieuwenhuijzen Jakko A, Zigeuner Richard, Dominguez-Escrig Jose L, Hacek Jaromir, Zlotta Alexandre R, Burger Maximilian, Evert Matthias, de Kaa Christina A Hulsbergen-van, van der Heijden Antoine G, Kiemeney Lambertus A L M, Soukup Viktor, Molinaro Luca, Hurle Rodolfo, Paciotti Marco, Moschini Marco, Pradere Benjamin, Perdonà Sisto, Gontero Paolo, Llorente Carlos, Algaba Ferran, Palou Joan, N'Dow James, Ribal Maria J, van der Kwast Theo H, Babjuk Marko, Sylvester Richard J, van Rhijn Bas W G
Аннотация
METHODS: We conducted a retrospective analysis of 2086 patients with IR-NMIBC classified according to the World Health Organization 1973 grading scheme. Multivariable Cox-regression models were fitted to identify predictors of recurrence, which were then used to dichotomize groups with low risk of recurrence (IR-Low) versus high risk of recurrence (IR-High). Kaplan-Meier curves were plotted to estimate recurrence-free survival (RFS) and progression-free survival (PFS). Smoothed hazard estimates of first recurrence were plotted by risk group.
KEY FINDINGS AND LIMITATIONS: Multifocality and tumor size ≥3 cm were significantly associated with higher risk of first recurrence and were used to define the IR-High and IR-Low (unifocal, size <3 cm; n = 1087) groups. The 3-yr RFS rate was significantly worse for the IR-High group (51%, 95% confidence interval [CI] 48-54%) than for IR-Low (68%, 95% CI 65-71%). The risk of progression was low (5-yr PFS rate 96%) with no significant difference between the IR-High and IR-Low groups.
CONCLUSIONS AND CLINICAL IMPLICATIONS: During IR-NMIBC follow-up for recurrence, tumor size and focality should be considered rather than grade. If the primary objective is to ensure prompt detection of recurrence, follow-up schedules should be tailored according to the risk of recurrence, with more stringent protocols for patients with IR-NMIBC at higher risk of recurrence.