American Urological Association non-muscle invasive bladder cancer risk model validation: should patient age be added to the risk model?
Ravvaz K, Weissert JA, Downs TM. American Urological Association Non-muscle Invasive Bladder Cancer Risk Model Validation: Should patient age be added to the risk model?. J Urol. 2019; 202(4): 682-688. doi: 10.1097/JU.0000000000000389.
PURPOSE: To evaluate the American Urological Association (AUA)/Society of Urologic Oncology (SUO) non-muscle invasive bladder cancer (NMIBC) risk model to predict NMIBC recurrence and progression prior to death.
MATERIALS AND METHODS: Retrospective analysis using electronic medical records and cancer registry data of patients with NMIBC within a multicenter U.S.
PATIENT POPULATION: We evaluated recurrence-free survival and progression-free survival according to the AUA/SUO NMIBC risk model. Then we assessed discriminative performance with concordance index (c-index). We then compared the cumulative incidence of recurrence, progression and death across four age groups.
RESULTS: We identified 1,297 patients with NMIBC. Median follow-up for the cohort was 3.2 years. The c-indices of the AUA/SUO model for recurrence were 0.62, while for progression they were higher at 0.77. Patients40% greater probability of NMIBC recurrence versus death, whereas, patients ≥84 years old had a 12% greater probability of death prior to recurrence at five years. This study is limited by its retrospective design.
CONCLUSION: The AUA/SUO NMIBC risk model provides similar predictive performance of recurrence and progression to previous NMIBC risk models such as EORTC, CUETO and NCCN. This work illustrates the need for considering age within predictive tools for clinicians treating patients with NMIBC.