Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Carbone Comprehensive Cancer Center, Madison (TMD), Wisconsin.
Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Carbone Comprehensive Cancer Center, Madison (TMD), Wisconsin.
J Urol. 2017 Oct;198(4):824-831. doi: 10.1016/j.juro.2017.04.077. Epub 2017 Apr 19.
We assessed the performance of the EORTC (European Organisation for Research and Treatment of Cancer) and CUETO (Club Urológico Español de Tratamiento Oncológico) nonmuscle invasive bladder cancer predictive models compared to current United States NCCN Guidelines® in an American population.
We retrospectively analyzed the electronic medical records of patients with nonmuscle invasive bladder cancer in a multicenter population in the United States. We evaluated recurrence-free and progression-free survival according to EORTC and CUETO, and assessed discriminative performance with the c-index at 1 and 5 years. We then compared the discrimination of EORTC and CUETO to the discrimination of the 4 nonmuscle invasive bladder cancer treatment groups described in NCCN Guidelines.
We identified 1,333 patients with nonmuscle invasive bladder cancer and a median followup of 37 months. At 5 years the recurrence c-index of EORTC and CUETO was 0.59 and 0.56 while for progression it was higher at 0.74 and 0.72, respectively. NCCN Guidelines demonstrated a similar c-index of 0.56 and 0.75, respectively. The discrimination of all 3 risk models decreased in patients who received bacillus Calmette-Guérin. EORTC was better able to identify patients at low risk for recurrence or progression but it overestimated the 5-year risk of progression in patients at high risk. This study was limited by its retrospective design.
Our work illustrates the need for improved predictive tools for clinicians who treat patients with nonmuscle invasive bladder cancer. However, until new tools are developed NCCN Guidelines are a simple option for clinicians who treat patients with nonmuscle invasive bladder cancer. Those guidelines provide predictive power comparable to that of the EORTC and CUETO models.
我们评估了 EORTC（欧洲癌症研究与治疗组织）和 CUETO（西班牙泌尿外科肿瘤治疗协会）非肌肉浸润性膀胱癌预测模型在美国人群中的表现，并与当前的美国 NCCN 指南®进行了比较。
我们回顾性分析了美国多中心人群中非肌肉浸润性膀胱癌患者的电子病历。我们根据 EORTC 和 CUETO 评估了无复发生存和无进展生存，并使用 1 年和 5 年的 c 指数评估了判别性能。然后，我们比较了 EORTC 和 CUETO 的判别能力与 NCCN 指南中描述的 4 种非肌肉浸润性膀胱癌治疗组的判别能力。
我们确定了 1333 例非肌肉浸润性膀胱癌患者，中位随访时间为 37 个月。5 年时，EORTC 和 CUETO 的复发 c 指数分别为 0.59 和 0.56，而进展时分别为 0.74 和 0.72。NCCN 指南的 c 指数分别为 0.56 和 0.75，相似。在接受卡介苗治疗的患者中，所有 3 种风险模型的判别能力均降低。EORTC 能够更好地识别低复发或进展风险的患者，但高估了高风险患者的 5 年进展风险。本研究受到其回顾性设计的限制。
我们的工作表明，需要为治疗非肌肉浸润性膀胱癌的临床医生开发更好的预测工具。然而，在新工具开发之前，NCCN 指南是治疗非肌肉浸润性膀胱癌患者的临床医生的一个简单选择。这些指南提供了与 EORTC 和 CUETO 模型相当的预测能力。
