Holz S, et al. - An appraisal was carried out of the risk factors related to the recurrence, progression and survival in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with bacillus Calmette–Guerin (BCG). It also entailed the validation of the European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) scores. In this study, the unfavourable predictors determined were carcinoma in situ (CIS) and tumor multiplicity. The superiority of CUETO model was established compared to the EORTC risk tables in speculating the recurrence and progression in the BCG-treated patient cohort. Both scores overestimated the recurrence and progression rates. The validation of the yielded data warranted advanced research.

Methods

• All the BCG-treated NMIBC patients were examined from 1998 to 2012.
• Multiple variables as risk factors for recurrence-free survival and progression-free survival (PFS) were investigated.
• Age, sex, grade, stage, tumor size, number of tumors, carcinoma in situ (CIS), recurrence status, BCG strain used, smoking status, use of re-staging transurethral resection and use of single immediate postoperative instillation served as the variables.
• The accuracy of EORTC and CUETO scores was computed in speculating the recurrence and progression.

Results

• 123 patients were enrolled.
• Median (interquartile range) follow-up was 49 months.
• The 5-year overall survival, cancer-specific survival, recurrence-free survival and PFS were 75.0%, 89.3%, 59.4% and 79.2%, respectively.
• Multiple tumors (≥3), concomitant CIS and smoking exerted an impact on the recurrence, on univariate analysis.
• In terms of progression, multiple tumors, concomitant CIS and Connaught strain (vs Tice) displayed a negative effect on the PFS on univariate and multivariate analyses, exhibiting as independent prognostic factors.
• It was noted that the CUETO scores were accurate, with a slight overestimation, while EORTC score did not appear to be predictive of recurrence or progression.