Time to progression is the main predictor of survival in patients with high-risk nonmuscle invasive bladder cancer: Results from a machine learning-based analysis of a large multi-institutional database.
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Porreca Annamaria, Di Nicola Marta, Lucarelli Giuseppe, Dorin Vartolomei Mihai, Soria Francesco, Terracciano Daniela, Mistretta Francesco Alessandro, Luzzago Stefano, Buonerba Carlo, Cantiello Francesco, Mari Andrea, Minervini Andrea, Veccia Alessandro, Antonelli Alessandro, Musi Gennaro, Hurle Rodolfo, Busetto Gian Maria, Del Giudice Francesco, Ferretti Simone, Perdonà Sisto, Prete Paola Del, Porreca Angelo, Bove Pierluigi, Crisan Nicolae, Russo Giorgio Ivan, Damiano Rocco, Amparore Daniele, Porpiglia Francesco, Autorino Riccardo, Piccinelli Mattia, Brescia Antonio, Tătaru Sabin Octavian, Crocetto Felice, Giudice Arturo Lo, de Cobelli Ottavio, Schips Luigi, Ferro Matteo, Marchioni Michele
Аннотация
METHODS: A total of 1,510 patients from 18 different institutions treated for T1 high grade NMIBC, followed by a secondary transurethral resection and BCG intravesical instillation. We relied on random survival forest (RSF) to rank covariates based on OS prediction. Cox's regression models were used to quantify the effect of covariates on mortality.
RESULTS: During a median follow-up of 49.0 months, 485 (32.1%) patients progressed to MIBC, while 163 (10.8%) patients died. The median time to progression was 82 (95%CI: 78.0-93.0) months. In RSF time-to-progression and age were the most predictive covariates of OS. The survival tree defined 5 groups of risk. In multivariable Cox's regression models accounting for progression status as time-dependent covariate, shorter time to progression (as continuous covariate) was associated with longer OS (HR: 9.0, 95%CI: 3.0-6.7; P < 0.001). Virtually same results after time to progression stratification (time to progression ≥10.5 months as reference).
CONCLUSION: Time to progression is the main predictor of OS in patients with high risk NMIBC treated with BCG and might be considered a coprimary endpoint. In addition, models including time to progression could be considered for patients' stratification in clinical practice and at the time of clinical trials design.