UROLOGICAL ONCOLOGY

Predicting Recurrence and Progression in Individual Patients with Stage Ta T1 Bladder Cancer Using EORTC Risk Tables: A Combined Analysis of 2596 Patients from Seven EORTC Trials
Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K
EORTC Data Center, Brussels, Belgium
Eur Urol. 2006; 49: 466-77

• Objectives: To provide tables that allow urologists to easily calculate a superficial bladder cancer patient’s short- and long-term risks of recurrence and progression after transurethral resection.
• Methods: A combined analysis was carried out of individual patient data from 2596 superficial bladder cancer patients included in seven European Organization for Research and Treatment of Cancer trials.
• Results: A simple scoring system was derived based on six clinical and pathological factors: number of tumors, tumor size, prior recurrence rate, T category, carcinoma in situ, and grade. The probabilities of recurrence and progression at one year ranged from 15% to 61% and from less than 1% to 17%, respectively. At five years, the probabilities of recurrence and progression ranged from 31% to 78% and from less than 1% to 45%.
• Conclusions: With these probabilities, the urologist can discuss the different options with the patient to determine the most appropriate treatment and frequency of follow-up.
  
  
• Editorial Comment
  The risk of superficial bladder cancer to recur or to progress is relatively well known. But how high is this risk exactly? Which factors contribute to recurrence, and, more importantly, to progression? How can the risks for an individual patient be calculated according to his or her individual risk factors?
  Clearly, the urologist would like to have nomograms at hand to help with these tasks – similar to the well-known Partin tables for prostate cancer.
  This hope became reality with the important work from Sylvester and coworkers. From the large database of the EORTC study group they calculated risk factors for superficial bladder cancer and created a model where the risk factors were evaluated in uni- and multivariate statistics. A scoring system helps to assess the probability of an individual patient for recurrence and progression. Interestingly, with regard to progression the recurrence status at the first follow-up cystoscopy is (next to CIS status) of prognostic importance. Only 8.7% of patients without a 3 month’s recurrence progressed, whereas 25.6% with a recurrence at 3 months suffered later progression.
  This paper is highly recommended reading for every urologist dealing with urothelial cancer.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany