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JU INSIGHT International Bladder Cancer Group Scoring System Predicts Outcomes of Patients on Active Surveillance

By: Wei Shen Tan, MD, PhD, FRCS, University of Texas MD Anderson Cancer Center, Houston; Roberto Contieri, MD, University of Texas MD Anderson Cancer Center, Houston, Humanitas University, Pieve Emanuele, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Nicolò Maria Buffi, MD, Humanitas University, Pieve Emanuele, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Giovanni Lughezzani, MD, Humanitas University, Pieve Emanuele, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Valentina Grajales, MD, MS, University of Texas MD Anderson Cancer Center, Houston; Mark Soloway, MD, Memorial Cancer Institute, Memorial Hospital, Hollywood, Florida; Paolo Casale, MD, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Rodolfo Hurle, MD, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Ashish M. Kamat, MD, MBBS, University of Texas MD Anderson Cancer Center, Houston | Posted on: 27 Nov 2023

Tan WS, Contieri R, Buffi NM, et al. International Bladder Cancer Group intermediate-risk nonmuscle-invasive bladder cancer scoring system predicts outcomes of patients on active surveillance. J Urol. 2023;210(5):763-770.

Study Need and Importance

Active surveillance (AS) for nonmuscle-invasive bladder cancer (NMIBC) is an underutilized concept for recurrent low-grade (LG) Ta/T1 NMIBC patients. Preserving patients’ quality of life by minimizing surgical intervention is important, but we must also ensure this does not cause harm. Towards this end, there are no good recommendations on how to best select these patients for AS.

What We Found

We utilized a prospective patient cohort (Bladder Cancer Italian Active Surveillance) of recurrent LG Ta/T1 NMIBC patients managed with AS with the following characteristics: ≤5 apparent LG NMIBC, tumor diameter ≤1 cm, no gross hematuria, and negative urinary cytology. Subsequent transurethral resection of bladder tumor (TURBT) was offered to patients who no longer met the inclusion criteria/patient choice. We then evaluated the ability of the International Bladder Cancer Group (IBCG) intermediate-risk (IR)–NMIBC scoring system to predict receipt of subsequent TURBT. Utilizing 163 patients with LG Ta/T1 NMIBC with a median follow-up of 33 months, multivariable Cox regression suggests that the IBCG IR-NMIBC scoring system was associated with subsequent TURBT (1-2 risk factors [HR: 1.66, 95% CI: 0.96-2.90, P = .072], ≥3 risk factors [HR: 3.21, 95% CI: 1.70-6.09, P < .001]) after adjusting for age, T-stage, and sex (Figure).

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Figure. Kaplan-Meier analysis for freedom from subsequent transurethral resection of bladder tumor (TURBT) stratified by risk factor (RF) groups according to patients (n = 163).

Limitations

The IBCG IR-NMIBC scoring system was applied retrospectively. Not all patients in the Bladder Cancer Italian Active Surveillance cohort had all the IBCG IR-NMIBC risk factors available (163 [76%] patients, 208 AS events [83%] included for analysis). Our cohort did not include the option for office fulguration of small subsequent LG Ta–appearing bladder tumors.

Interpretation for Patient Care

For patients on AS for LG NMIBC, our data report that the IBCG IR-NMIBC scoring system predicts the likelihood of continued AS. As such, the scoring system can be used to counsel patients regarding the need for a delayed TURBT when embarking on an AS program.

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