使用危險模型評估膀胱刮除後表淺性膀胱尿路上皮癌預後-台灣確認分析研究
陳昱光1、林子平1,2、張延驊1,2、郭俊逸1,2、黃志賢1,2、鍾孝仁1,2、吳宏豪1,2、盧星華1,2、黃逸修1,2、林志杰1,2、范玉華1,2、黃奕燊1,2、
呂仕彥3、林登龍1,2、陳光國1,2
台北榮民總醫院泌尿部1；國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心2；台北榮民總醫院新竹分院外科部3
Application of risk models to predict outcomes in non-muscle invasive bladder urothelial carcinoma patient after transurethral tumor resection- external validation in Taiwan
Yu-Kuang Chen1, Tzu-Ping Lin1,2, Yen-Hwa Chang1,2, Junne Yih Kuo 1,2, William J.S. Huang1,2, Hsiao-Jen Chung1,2, Howard H.H Wu1,2, Shing-Hwa Lu1,2, Eric Yi-Hsiu Huang1,2, Chi-Cheh Lin1,2, Y.H. Fan1,2, I-shen Huang1,2, Shih-Yen Lu3, Alex T.L. Lin1,2, Kuang-Kuo Chen1,2
Department of Urology, Taipei Veterans General Hospital1,
Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang-Ming University2, Department of Surgery, Taipei Veterans General Hospital Hsinchu branch3
Purpose
Risk stratification with different risk models in bladder cancer have been introduced for prognosis prediction, including European Organization for Research and Treatment of Cancer (EORTC) risk tables, and Spanish Urological Club for Oncological Treatment (CUETO) scoring model. Both have their limitations especially using 1973 WHO grading system. More recently, the Risk Stratification System in AUA/SUO Guideline categorized the patients into low/intermediate/high risk group, offer a simple way for clinicians to determined treatment plan. However, the aforementioned risk tables are developed based of western population. We aim to evaluate the accuracy of these risk models with our single medical center database in Taiwan.
Materials and Methods
Among JAN 2007 and DEC 2015, 1613 patients with pathology report of non-muscle invasive bladder urothelial carcinoma were enrolled. Patients with history of upper tract urothelial carcinoma, primary (pure) CIS and muscle invasive bladder cancer (MIBC) were excluded. The definition of recurrence was reappearance of urothelial carcinoma within the bladder, and progression was advancing in stage, metastasis or death caused by urothelial carcinoma. EORTC risk score has been calculated for each patient and was assigned in to groups as predictor. Regression model for recurrence and progression were created and obtained the concordance indexes, which we compared to EORTC model.
Results
Total 1103 patients were in the cohort, with a 46-month follow-up in average. The mean age was 73 (±12.7) years old, and there were 902 (81.8%) male patients, 148 (13.8%) concurrent CIS. Four hundred seventy-seven (43.2%) patients experienced recurrence and 163 (14.8%) experienced progression. The concordance index of disease recurrence and progression (0.603 and 0.627 respectively) in our patients were lower than EORTC trial reported (0.660 and 0.740 for 1 year, 0.660 and 0.750 for 5 years).
Conclusions
In our single institute cohort, EORTC risk tables might be a suboptimal tool for predicting outcomes. The recurrence and progression rate of our non-muscle invasive bladder cancer patients were lower than predicted by EORTC risk tables.