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New predictive scoring model for recurrence incorporating bladder neck involvement in patients with non-muscle-invasive bladder cancer

Login to Access Video or Poster Abstract: MP15-04
Sources of Funding: none

Introduction

We previously reported that bladder neck involvement (BNI) was an independent risk factor for progression to muscle invasion in primary non-muscle-invasive bladder cancer (NMIBC) and we developed a new predictive scoring model for progression incorporating BNI (Fujii et al., Eur Urol 1998; Kobayashi and Fujii et al., Urol Oncol 2014). In the present study, we investigated the impact of BNI on recurrence in NMIBC, and developed a new predictive scoring model for recurrence incorporating BNI and assessed its predictive ability.

Methods

We enrolled a total of 589 Japanese patients who underwent transurethral resection for bladder tumors at a single center from 2001 to 2016, and who were pathologically diagnosed with Ta and T1 NMIBC. Exclusion criteria were: carcinoma in situ and patients with tumors located in the prostatic urethra. Multivariate Cox proportional hazards regression models using the Prentice-Williams-Peterson gap time model were generated to identify the independent predictors for recurrence. The predictive ability of our model was assessed using Harrell&[prime]s concordance index (c-index) and was compared with that of the EORTC and CUETO scoring models.

Results

Over a median follow-up period of 3.1 years, 258 patients (43.8%) experienced a total number of 475 recurrences, and the disease progressed in 37 patients (6.3%). The recurrence probability at 3 years was 49.7%. In 106 patients (18.0%) with current and prior history of BNI, subsequent recurrence probability at 3 years was 67.2%. Multivariate analysis revealed that history of BNI (HR 1.60, P < 0.001) along with histologic grade 2-3 (HR 1.53, P = 0.020), multiple tumors of four or more (HR 1.37, P = 0.016) and male (HR 1.30, P = 0.043) were independent predictors of recurrence. Our scoring model of assigning 1 point to each risk variable represented higher c-index of 0.59 than the EORTC (0.57) and CUETO (0.50) models. Dividing patients into 3 groups according to their scores (0-1/2/3-4), recurrence rates increased as the score (P <0.001).

Conclusions

This study showed that current and prior history of BNI is a significant risk factor for recurrence in NMIBC. Our scoring model incorporating BNI is an easy means of estimating recurrence risk and can be used to determine the appropriate management for individual patients.

Funding

none

Authors
Yuma Waseda
Masaharu Inoue
Masaya Ito
Toshiki Kijima
Soichiro Yoshida
Minato Yokoyama
Junichiro Ishioka
Yoh Matsuoka
Kazutaka Saito
Kazunori Kihara
Yasuhisa Fujii
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