Study Predicts Risk of Recurrence, Progression for Patients With NMIBC

Data from a community-based cohort study of patients with nonmuscle-invasive bladder cancer (NMIBC) suggest that 1- and 5-year high-risk recurrences and progression increase with higher tumor classification and grade at diagnosis (Cancer. 2021;127[4]:520-527).

Risk calculators that are currently available can only estimate recurrence and progression, but do not predict the recurrence stage or grade, said the study investigators, who aimed to bridge this gap.

Between 1994 and 2015, a total of 2956 patients were diagnosed with NMIBC (<T2) at Kaiser Permanente Northwest and Geisinger. From these patients’ data, 4 risk-stratified outcomes were created based on tumor classification and grade of recurrence. These outcomes included any recurrence; intermediate‐risk recurrence (Ta high grade, carcinoma in situ, T1 low grade) or higher; high‐risk recurrence (T1 high grade) or progression (clinical T2); and progression.

The researchers found that over a median follow-up of 29.4 months, there were 1062 (35.9%) documented recurrences and 111 (3.8%) progressions. The adjusted hazard ratio was 2.60 (95% CI, 1.62-4.15) for Ta high-grade tumors, 4.74 (95% CI, 3.01‐7.47) for tumor in situ or Ta with carcinoma in situ, and 7.14 (95% CI, 4.97‐10.26) for T1 high‐grade tumors.

Based on these findings, the investigators proposed that Ta high-grade tumors have a 1-year and 5-year predicted rate of adjusted risk of a high-risk recurrence of progression of 4.4% and 7.9%, respectively.

“The 1-year and 5-year predicted risk of high-risk recurrences and progression increased with higher tumor classification and grade at diagnosis. These granular risk estimates may further inform risk-stratified treatment and surveillance for patients with NMIBC,” they concluded.—Emily Bader

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