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

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...

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Autores: Contieri, R, Martini, A, Beijert, IJ, Mertens, LS, Hentschel, AE, Brundl, J, Compérat, EM, Plass, K, Rodríguez, O, Henríquez, JDS, Hernández, V, de la Pena, E, Alemany, I, Turturica, D, Pisano, F, Soria, F, Capoun, O, Bauerova, L, Pesl, M, Bruins, HM, Runneboom, W, Herdegen, S, Breyer, J, Brisuda, A, Calatrava, A, Rubio-Briones, J, Seles, M, Mannweiler, S, Bosschieter, J, Kusuma, VRM, Ashabere, D, Huebner, N, Seisen, T, Claps, F, Masson-Lecomte, A, Liedberg, F, Cohen, D, Lunelli, L, Cussenot, O, El Sheikh, S, Volanis, D, Cote, JF, Roupret, M, Haitel, A, Shariat, SF, Mostafid, AH, Nieuwenhuijzen, JA, Zigeuner, R, Dominguez-Escrig, JL, Hacek, J, Zlotta, AR, Burger, M, Evert, M, van de Kaa, CA, van der Heijden, AG, Kiemeney, LALM, Soukup, V, Molinaro, L, Hurle, R, Paciotti, M, Moschini, M, Pradere, B, Perdona, S, Gontero, P, Llorente, C, Algaba, F, Palou, J, N'Dow, J, Ribal, MJ, van der Kwast, TH, Babjuk, M, Sylvester, RJ, van Rhijn, BWG
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p20378
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20378
Access Level:acceso abierto
Palabra clave:Non-muscle-invasive bladder cancer
Follow-up
Risk
Stratification
Intermediate risk
Descripción
Sumario: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. (c) 2025 European Association of Urology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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