Development and Validation of a Novel Recurrence Risk Stratification for Initial Non-Muscle Invasive Bladder Cancer in the Han Chinese Population

Abstract

Background: Some classification models for determining the risk of recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) had some shortcomings in clinical applications. This study aimed to investigate whether the European Organization for Research and Treatment of Cancer (EORTC) risk stratification was useful to predict the recurrence of NMIBC in the Han Chinese population. In addition, we developed and validated a novel risk stratification method for recurrence prediction of NMIBC. Methods: Excluding cases who do not meet the inclusion criteria, 606 patients with NMIBC from the First Affiliated Hospital of Zhengzhou University were included in the testing and validation groups. The recurrence-free survival (RFS) curve according to the EORTC risk classifications was calculated by the Kaplan-Meier and the log-rank test methods. Receiver operating characteristic (ROC) curve analysis was used to estimate the diagnosis value for recurrence. We built a logistic regression model for recurrence in NMIBC patients combining the independent recurrence prognostic factors. One external validation group including 166 patients with NMIBC from the Zhongnan Hospital of Wuhan University was also used to assess the logistic regression model. Results: There was no significant difference in RFS rates between the groups grouped according to EORTC. We constructed a novel risk model to predict recurrence by classifying patients into two groups using ten independent prognostic factors [bladder cancer-specific nuclear matrix protein 4 (BLCA-4), bladder tumour antigen (BTA), nuclear matrix protein 22 (NMP22), carcinoembryonic antigen (CEA), body mass index, smoking, family history of bladder cancer, occupational exposure to aromatic amine chemicals, number of tumours, bladder instillation of chemotherapeutic agents] to predict tumour recurrence based on logistic regression analyses (testing group). According to the novel recurrence risk classification, there was a significant difference in 5-year RFS rates between the low-risk group and the high-risk group (Validation group and the external validation group). Conclusions: Our novel classification model can be a useful tool to predict recurrence risk in the Han Chinese population with NMIBC.

Meta-analysis of global variations in grade of pT1 urothelial bladder cancer and supplementary evaluation of a Sri Lankan cohort

“…Wang et al in their EORTC risk table study on a Chinese population identified a low percentage of G1 tumours -18.6% in the study group; 20.0% in the validation group; 22.9% in the external validation group. [55] This phenomenon was similar in Japanese reports with G1 being 13-24% [56][57][58] and in Korean patients 22%. [59] This is in contrast to large population studies from Europe where the G1 percentage is higher, 33% [5] and 43%.…”

Current Researches on Nanodrug Delivery Systems in Bladder Cancer Intravesical Chemotherapy

“…The recurrence rate after TURBT for NMIBC is 50% to 80% ( 95 ), and prevention of bladder cancer recurrence after surgery is a key aspect to improve the prognosis of bladder cancer patients. Bladder perfusion chemotherapy is an effective mean of preventing tumor recurrence, but the tumor suppressive effect of the drugs reduces due to the barrier effect of bladder epithelium and regular urination behavior ( 61 , 96 , 97 ).…”

Did the Scientific Innovations in the Management of Non-Muscle Invasive Bladder Cancer Patients Improve the Outcome during the Last 2 Decades?

“…Some studies developed other stratification methods based on clinicopathological characteristics, urine biomarkers, and life-history traits. Wang et al [19] developed novel recurrence risk stratification based on ten prognostic factors [bladder cancer-specific nuclear matrix protein 4 (BLCA-4), bladder tumor antigen (BTA), nuclear matrix protein 22 (NMP22), carcinoembryonic antigen (CEA), body mass index, smoking, family history of bladder cancer, occupational exposure to aromatic amine chemicals, number of tumors, bladder instillation of chemotherapeutic agents] to predict tumor recurrence A group from Japan proposed another novel risk stratification model, the Japanese NIshinihon uro-oncology Extensive collaboration group (J-NICE), consisting of seven factors to predict recurrence, progression, and cancer-specific death after stratification of their patients according to the score-All these novel new models needs further external validation to strengthen its clinical impact [20].…”