Management Of Superficial Bladder Tumors

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 13 Apr 2008 - 0:00 PDT

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UroToday.com - A Scoring System Based on Multivariate Analysis of Data from Four Randomized CUETO Trials

The Spanish research group CUETO presented a study to develop a risk-stratification model to allow accurate prediction of recurrence and progression risk after intravesical adjuvant Bacillus Calmette-Guerin (BCG) immunotherapy, in patients with high and intermediate risk non-muscle invasive transitional cell carcinoma of the bladder.

Data of 1,062 patients treated with BCG were analyzed. All patients had been included in four CUETO Group prospective randomized trials: 90008 (n: 493), 93009 (n: 383), 95011 (n: 296) and 95012 (n: 151). Stepwise multivariate regression models with stratification by study and dose were used to assess the independent effect of predictive factors. The hazard ratios and ß coefficients of these factors were re-estimated for constructing the predictive model. Finally, a scoring system to predict recurrence and progression was developed.

For recurrence, the variables included in the predictive model were gender (male, female), age (< 60, ≥ 60), grade (G3, G2), tumor status (primary, recurrent), multiplicity (≤ 3, > 3) and presence of associated TIS (Yes, No). For progression, the variables included were age (< 60, ≥ 60), grade (G3, G2), tumor status (primary, recurrent), T category (Ta, T1), multiplicity (≤ 3, > 3) and presence of associated TIS (Yes, No). By weighing the score of each variable, a complete scoring system allowed assigning each patient to different prognostic groups. In this way, the probabilities of recurrence at one and five years ranged from 5 to 33% and from 14 to 56%, respectively. For progression, the probabilities at one and five years ranged from less than 1% to 10% and 2 to 28%, respectively.

The proposed scoring model provides an improved method for evaluating the prognosis and helps to stratify the risk of recurrence and progression to muscle invasive disease in patients with non-muscle invasive bladder tumors treated with BCG.

Presented by: J.M. Fernandez-Gomez, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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