Center for Health Research-Kaiser Permanente Northwest, Portland, OR.
Center for Health Research-Kaiser Permanente Northwest, Portland, OR.
Urol Oncol. 2020 Feb;38(2):39.e21-39.e27. doi: 10.1016/j.urolonc.2019.10.003. Epub 2019 Nov 9.
To externally validate the European Organization for the Research and Treatment of Cancer (EORTC) risk calculator and National Comprehensive Cancer Network (NCCN) guidelines in a contemporary population of U.S. non-muscle-invasive bladder cancer (NMIBC) patients treated in a community-based setting and compare our findings to those from another U.S. health system.
We identified 1,491 NMIBC patients with a median follow-up of 2.1 years (recurrence) and 4.1 years (progression). We calculated NCCN risk groupings and EORTC prognostic index for recurrence and progression. We followed Royston and Altman's guidelines for the external validation of prognostic calculators.
For predicting recurrence using the EORTC framework, Harrell's C (a measure of discrimination) was smaller in our sample (0.66) than in the European Association of Urology sample (0.61), whereas for progression, Harrell's C was larger in our sample (0.78 vs. 0.75). The EORTC calculator overestimated progression risk in the highest stratum for our sample; calibration and discrimination were adequate for all groups except the highest risk group. For NCCN risk groupings, Harrell's C was 0.54 for recurrence and 0.62 for progression, suggesting poor to fair discrimination in our sample. The NCCN framework had slightly better performance for predicting progression vs. recurrence.
Existing NMIBC risk-stratification frameworks have acceptable accuracy to predict outcomes. However, further innovation in NMIBC care will require predictive tools with more granularity to reflect the differential risks of subgroups of NMIBC recurrence, prior treatment histories, and other prognostic variables.
在一个美国社区环境中接受治疗的非肌肉浸润性膀胱癌（NMIBC）患者的当代人群中，对欧洲癌症研究与治疗组织（EORTC）风险计算器和国家综合癌症网络（NCCN）指南进行外部验证，并将我们的研究结果与另一个美国卫生系统的研究结果进行比较。
我们确定了 1491 例 NMIBC 患者，中位随访时间为 2.1 年（复发）和 4.1 年（进展）。我们计算了 NCCN 风险分组和 EORTC 预后指数以预测复发和进展。我们遵循 Royston 和 Altman 的建议对预后计算器进行外部验证。
使用 EORTC 框架预测复发时，我们样本中的 Harrell C（一种衡量区分度的指标）小于欧洲泌尿外科学会样本（0.61），而对于进展，我们样本中的 Harrell C 较大（0.78 比 0.75）。对于我们的样本，EORTC 计算器高估了最高分层的进展风险；校准和区分度在除了最高风险组之外的所有组中均足够。对于 NCCN 风险分组，Harrell C 为 0.54 用于预测复发，0.62 用于预测进展，表明我们的样本中区分度较差。NCCN 框架在预测进展方面比预测复发具有稍好的性能。
现有的 NMIBC 风险分层框架具有预测结果的可接受准确性。然而，NMIBC 护理的进一步创新将需要具有更细粒度的预测工具，以反映 NMIBC 复发、既往治疗史和其他预后变量的亚组的不同风险。
