Towards Defining Follow-up Strategies for Patients with Primary Intermediate-risk Non–muscle-invasive Bladder Cancer

IF 9.3 1区医学 Q1 ONCOLOGY

European urology oncology Pub Date : 2025-08-01 DOI:10.1016/j.euo.2025.04.010

Roberto Contieri , Alberto Martini , Irene J. Beijert , Laura S. Mertens , Anouk E. Hentschel , Johannes Bründl , Eva M. Compérat , Karin Plass , Oscar Rodríguez , Jose D. Subiela Henríquez , Virginia Hernández , Enrique de la Peña , Isabel Alemany , Diana Turturica , Francesca Pisano , Francesco Soria , Otakar Čapoun , Lenka Bauerová , Michael Pešl , H. Maxim Bruins , Bas W.G. van Rhijn

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引用次数: 0

Abstract

Background and objective

The current European Association of Urology (EAU) guidelines on non–muscle-invasive bladder cancer (NMIBC) categorize patients into four risk groups. In 2024, a specific follow-up schedule was introduced for intermediate-risk (IR) disease. However, recommendations are based on expert opinion and restricted to patients with IR-NMIBC who have primary low-grade or high-grade/grade 2 disease. Our aim was to identify a subgroup of patients with IR-NMIBC who may require more stringent follow-up.

Methods

We conducted a retrospective analysis of 2086 patients with IR-NMIBC classified according to the World Health Organization 1973 grading scheme. Multivariable Cox-regression models were fitted to identify predictors of recurrence, which were then used to dichotomize groups with low risk of recurrence (IR-Low) versus high risk of recurrence (IR-High). Kaplan-Meier curves were plotted to estimate recurrence-free survival (RFS) and progression-free survival (PFS). Smoothed hazard estimates of first recurrence were plotted by risk group.

Key findings and limitations

Multifocality and tumor size ≥3 cm were significantly associated with higher risk of first recurrence and were used to define the IR-High and IR-Low (unifocal, size <3 cm; n = 1087) groups. The 3-yr RFS rate was significantly worse for the IR-High group (51%, 95% confidence interval [CI] 48–54%) than for IR-Low (68%, 95% CI 65–71%). The risk of progression was low (5-yr PFS rate 96%) with no significant difference between the IR-High and IR-Low groups.

Conclusions and clinical implications

During IR-NMIBC follow-up for recurrence, tumor size and focality should be considered rather than grade. If the primary objective is to ensure prompt detection of recurrence, follow-up schedules should be tailored according to the risk of recurrence, with more stringent protocols for patients with IR-NMIBC at higher risk of recurrence.

查看原文本刊更多论文

确定原发性中危非肌浸润性膀胱癌患者的随访策略。

背景和目的：目前欧洲泌尿外科协会（EAU）关于非肌肉浸润性膀胱癌（NMIBC）的指南将患者分为四个危险组。2024年，引入了针对中等风险（IR）疾病的特定随访计划。然而，建议是基于专家意见，并且仅限于原发性低级别或高级别/ 2级疾病的IR-NMIBC患者。我们的目的是确定一个可能需要更严格随访的IR-NMIBC患者亚组。方法：我们对2086例按照世界卫生组织1973年分级方案分类的IR-NMIBC患者进行回顾性分析。拟合多变量cox回归模型以确定复发的预测因子，然后将复发风险低（IR-Low）和复发风险高（IR-High）分组。绘制Kaplan-Meier曲线来估计无复发生存期（RFS）和无进展生存期（PFS）。按风险组绘制首次复发的平滑风险估计值。主要发现和局限性：多灶性和肿瘤大小≥3 cm与首次复发的高风险显著相关，并用于定义IR-High和IR-Low（单灶性，大小）结论和临床意义：在IR-NMIBC随访复发时，应考虑肿瘤大小和灶性，而不是分级。如果主要目的是确保及时发现复发，则应根据复发风险量身定制随访计划，对于复发风险较高的IR-NMIBC患者，应采用更严格的方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology oncology Multiple-

CiteScore

15.50

自引率

2.40%

发文量

128

审稿时长

20 days

期刊介绍： Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format