Current National Comprehensive Cancer Network (NCCN) guidelines are comparable to European models for predicting nonmuscle-invasive bladder cancer recurrence and progression. But better models are needed, according to a recent study.
“A fair amount of urology involves caring for oncology patients, and urologist are definitely at the frontlines in these conversations [with nonmuscle-invasive bladder cancer patients],” said senior author Tracy M. Downs, MD, of the University of Wisconsin School of Medicine and Public Health, Madison. “What I think this study shows is that we need better predictive models…, and the less complicated NCCN guidelines are equally as helpful and had the same limitations as the more rigorous EORTC and CUETO models.”
For the study, which was published in the Journal of Urology (2017; 198:824-31), Dr. Downs and colleagues retrospectively studied the electronic medical records of 1,333 nonmuscle-invasive bladder cancer patients. In an average follow-up of 37 months, they evaluated recurrence-free and progression-free survival at 1 and 5 years with the European Organisation for Research and Treatment of Cancer (EORTC) and Club Urologico Espanol de Tratamiento Oncologico (CUETO) guidelines; then, compared that to the predictive power of NCCN’s guidelines.
This is the first external validation study of the European models in a U.S. population of nonmuscle-invasive bladder cancer patients at multiple centers and comparing the predictive ability of those models to that of the NCCN guidelines, according to the authors.
The authors reported that 573 patients recurred in the study—a 28% cumulative probability of recurrence at 1 year and 47% at 5 years. The recurrence c-index of EORTC was 0.59 and 0.56 for CUETO at 5 years. For progression, EORTC was 0.74 and CUETO 0.72. NCCN’s model showed a c-index of 0.56 for recurrence and 0.75 for progression.