EORTC scores of recurrence and progression in a Romanian cohort

First author: Anda ŞtefanCo-authors: Radu Mihail Boja, PhD

Ovidiu Ioan Golea, PhD Ladislau Schwarts, PhD Sever Chiujdea

Coordinators: Assistant Professor Mihai Vartolomei

Associate Professor Orsolya Martha

Introduction

The European Organization for Research and Treatment of Cancer (EORTC) developed a scoring system and risk tables in order to predict the recurrence and progression in case of non-muscle-invasive bladder cancers (NMIBC);

The EORTC study was done in various countries, but it was never performed on a Romanian population.

Introduction and Objective

The term «progression» refers to the process of developing gradually towards a more advanced state (in our case towards a muscle invasive bladder cancer);

«Recurrence» means the return of a sign, symptom, or disease after a remission.

The aim of this study was to correlate the EORTC score with the recurrence and the progression in a Romanian cohort with NMIBC.

Material and method

We have realized a retrospective study on a total number of 305 patients admitted in the Urology Clinic of Târgu-Mureş with NMIBC, during 1st of January 2006 and 31st of December 2008, with an average follow-up period of 42 months.

The inclusion criteria were: bladder tumor at the first manifestation, treated by TUR-B (transurethral resection), T grade ≤T1;

The exclusion criteria was the lack of follow-up (15 patients).

Patients characteristics

Results Recurrence free survival

12 months: 78.6%36 months: 72.5%

p-0.001

yes no

0

2

4

6

8

reccurence

Recurrence appeared in the case of 77 patients.

ResultsProgression free survival

12 months: 92.4%36 months: 88.8%60 months: 75%

p-0.0001

yes no

0

5

10

15

20

progresion

Progression appeared in the case of 34 patients

Progression and recurrence in patients treated with Bacillus Calmette–Guérin (BCG)

p= 0.001 p= 0.8

EORTC risk scores comparison

Recurrence

EORTC study

Our cohort

EORTC study

Our cohort

12 months

12 months

60 months

36 months

0 15% 0% 31% 5.3%

1-4 24% 13.8% 46% 20.5%

5-9 38% 34.1% 62% 39.9%

Progression

EORTC study

Our cohort

EORTC study

Our cohort

12 months

12 months

60 months

60 months

0 0.2% 0% 0.8% 2.1%

1-6 1% 3.7% 6% 11.9%

7-13 5% 11.7% 17% 45.9%

14-23 17% 27.8% 45% 34%*36

monthsThe EORTC study was performed on a total number of 2596 patients.

Kaplan-Meier survival curves based on EORTC risk scores

High riskHigh risk

Discussions

NMIBC is a common disease with highly variable behavior and outcome;

EORTC risk score tables help predict the recurrence and progression rate in the case of NMIBC;

From our results we noticed that patients with high-risk G3T1 should be followed carefully for recurrence and progression, and BCG treatment is mandatory for preventing progression towards muscle invase bladder cancer.

Also we found that progression rate was higher in our cohort than in the EORTC study, probably because of the high number of high-risk patients with G3 or T1 in our cohort.

From our knowledge, this is the first study realized in our country regarding the EORTC risk scores.

DiscussionsOther studies revealed similar findings:

A patient`s short and long-term probabilities of recurrence and progression can easily be calculated with a simple scoring system. [1]

In providing the long-term outcome of initially diagnosed TaG1 NMIBC after TUR-B, the present study provides an important external validation of the EORTC score for recurrence prediction. [2]

A significant concordance was noted between the EORTC’s predicted risk and the actual recurrence rate of stage Ta T1 bladder cancer at 1 year. [3]

Clinical utilization of the EORTC scoring system and risk tables is very effective in predicting the recurrence and progression of non-muscle-invasive bladder cancer. [4]

Conclusions

EORTC scores are an useful tool in predicting the recurrence and progression in NMIBC, even for Romanian patients and should be used in daily clinical practice;

Patients with high risk for progression and recurrence should benefit from a careful follow-up;

Despite the minimal differences, these tables provide the clinicians with a good starting point for discussing therapeutic options.

Bibliography [1] Sylvester RJ, van der Meijden AP: ”Predicting recurrence and progression in individual

patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials.” European Urology 49 (2006) 466-477;

[2] Bosset PO, Neuzillet Yann: ”Long-term follow-up of TaG1non–muscle-invasive bladder cancer.” Urologic Oncology: Seminars and Original Investigations (2015)20.e1–20.e7;

[3] Ather MH: ”Predicting Recurrence and Progression in Non Muscle Invasive Bladder Cancer Using European Organization of Research and Treatment of Cancer Risk Tables.” Urology Journal (2009), vol. 6:189-93;

[4] Seo KW, Kim BH : ”The Efficacy of the EORTC Scoring System and Risk Tables for the Prediction of Recurrence and Progression of Non-Muscle-Invasive Bladder Cancer after Intravesical BCG Instillation.” Korean J Urol 2010;51:165-170;

[5] Xylinas E, Kent M: ”Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder.” British Journal of Cancer (2013) 109, 1460–1466;

[6] Sylvester RJ: ”Natural History, Recurrence, and Progression in Superficial Bladder Cancer.” The Scientific World JOURNAL (2006) 6, 2617–2625;

[7] Walczak R, Bar K: ”The value of EORTC risk tables in evaluating recurrent NMIBC in everyday practice.” Central European Journal of Urology 2013; 66: 418-422;

[8] Vedder MM, Marquez M: ”Risk Prediction Scores for Recurrence and Progression of Non-Muscle Invasive Bladder Cancer: An International Validation in Primary Tumours.” PLOS ONE June 2014 | Volume 9 | Issue 6 | e96849;

[9] Pillai Rajiv: ”Application of EORTC Risk Tables for Non–Muscle Invasive (pTa/pT1) Bladder Cancer Recurrence and Progression in a Local Cohort.” The Scientific World JOURNAL (2011) 11, 751–759.