Calculator predicts prognoses in Ta/T1 bladder cancer

Atlanta-A calculator that can instantly predict short-and long-term risks of recurrence and progression in patients with stage Ta/T1 bladder cancer is a few clicks away.

Richard Sylvester, ScD, assistant director and head of biostatistics at the European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, together with his colleagues in the EORTC Genito-Urinary Tract Cancer Group, have analyzed data from 2,596 stage Ta and T1 bladder cancer patients from seven EORTC phase III trials in order to create a simple calculator that can be downloaded free from the EORTC web site: http://www.eortc.be/tools/bladdercalculator/default.htm

"The goal of this effort is to provide a tool for urologists that will allow them to easily calculate a patient's probability of recurrence and progression based on their tumor characteristics at initial diagnosis and at the time of recurrence," said Dr. Sylvester, who presented his finding at the AUA annual meeting and published them in European Urology (2006; 49:466-77). "It is similar in concept to Michael Kattan's nomograms for prostate cancer. However, nothing like this tool existed up until now for noninvasive bladder cancer.

The data to identify reliable prognostic factors were buried in the mass of information the EORTC has been gathering since the mid-1970s, but had to be rooted out. The investigators were able to cull data on 2,596 patients with stage Ta/T1 cancers from seven EORTC bladder cancer trials.

Initially, 11 factors that might be used to predict recurrence and progression were evaluated. These were age, gender, prior treatment, prior tumor status, prior recurrence rate, number of tumors (single, two to seven, eight or more), tumor size (<3 cm, ≥3 cm), tumor stage (Ta, T1), grade (G1, G2, G3), concomitant carcinoma in situ, and recurrence at the 3-month cystoscopy.

Six of these factors achieved sufficient significance to be included in the final formula. The most important factors predicting the risk of recurrence were the number of tumors, prior recurrence rate, and tumor size. The most important factors predicting progression were concomitant carcinoma in situ, grade, and stage.

Each of these items is given a weight (score) that is factored into a formula that provides the prognosis. The risk of recurrence at 1 year falls between 15% and 60%, and the probability of progression at 5 years ranges from 1% to 45%.

User friendly

Clinicians need not bother with the mathematics because the investigators have incorporated the scores into a computer calculator that can be downloaded to a desktop, laptop, or handheld (Palm or Windows CE) computer. The user checks off the appropriate categories in the calculator and clicks "calculate probabilities."

Dr. Sylvester thinks this simple program can have a major effect on therapeutic decisions.

"This tool is easy to apply. It is based on six simple, readily available factors that will give you a patient's probability of recurrence and progression at 1-year intervals for 5 years. Based on this information, you can tailor your therapy and follow-up.

"For instance, a patient with a relatively low risk of recurrence and progression may need only one immediate post-TUR instillation of intravesical chemotherapy and perhaps nothing more. A patient with an intermediate risk of recurrence but a low risk of progression may be given an immediate instillation followed by further instillations of chemotherapy. If a patient has a high risk of recurrence or an intermediate to high risk of progression, consideration should be given to BCG," Dr. Sylvester said.