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A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: the J-NICE risk tables

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Abstract

Background

The aim of this study is to establish new risk tables for the current clinical setting, enabling short- and long-term risk stratification for recurrence, progression, and cancer-specific death after transurethral resection in non-muscle invasive bladder cancer (NMIBC). Currently available risk tables lack input from the 2004 World Health Organization grading system and risk prediction for cancer-specific death.

Methods

This was a multi-institutional database study of 1490 patients diagnosed with NMIBC (the development cohort). A multivariate Fine and Gray subdistribution hazard model was used to assess the prognostic impact of various factors. Patients were classified into low-, intermediate-, and high-risk groups according to a sum of the weight of selected factors, and predicted cumulative rates were calculated. Internal validation was conducted using 200 bootstrap resamples to assess the optimism for the c-index and estimate a bias-corrected c-index. External validation of the developed risk table was performed on an independent dataset of 91 patients.

Results

The Japanese NIshinihon uro-onCology Extensive collaboration group (J-NICE) risk stratification table was derived from six, five, and two factors for recurrence, progression, and cancer-specific death, respectively. The internal validation bias-corrected c-index values were 0.619, 0.621, and 0.705, respectively. The application of the J-NICE table to an external dataset resulted in c-indices for recurrence, progression, and cancer-specific death of 0.527, 0.691, and 0.603, respectively.

Conclusions

We propose a novel risk stratification model that predicts outcomes of treated NMIBC and may overcome the shortcomings of existing risk models. Further external validation is required to strengthen its clinical impact.

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Abbreviations

BCa:

Bladder cancer

BCG:

Bacillus Calmette–Guerin

CI:

Confidence interval

CIS:

Carcinoma in situ

CSD:

Cancer-specific death

CUETO:

Spanish Urological Club for Oncological Treatment

EORTC:

European Organization for Research and Treatment of Cancer

ISUP:

International Society of Urological Pathology

NICE:

Nishinihon uro-oncology extensive collaboration group

NMIBC:

Non-muscle invasive bladder cancer

TURBT:

Transurethral resection of the bladder tumor

UC:

Urothelial carcinoma

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Makito Miyake, Yasushi Nakai & Kiyohide Fujimoto

  2. Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, 755-8505, Japan

    Hideyasu Matsuyama & Hiroaki Matsumoto

  3. Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan

    Satoshi Teramukai & Fumie Kinoshita

  4. Department of Biostatistics, Graduate of Medicine, Hokkaido University, Kita15 Nishi7, Kita-ku, Sapporo, 060-8638, Japan

    Isao Yokota

  5. Department of Pathology, Nara City Hospital, 1501 Higashi kidera-cho, Nara-shi, Nara, 630-8305, Japan

    Keiji Shimada

  6. Department of Pathology, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu-shi, Fukuoka, 805-0050, Japan

    Mitsuru Kinjyo & Tatsuro Shimokama

  7. Department of Urology, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu-shi, Fukuoka, 805-0050, Japan

    Koji Okumura

  8. Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Masaya Yomenori, Hideki Enokida & Masayuki Nakagawa

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  1. Makito Miyake
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Nishinihon Uro-oncology Extensive Collaboration group

Corresponding author

Correspondence to Kiyohide Fujimoto.

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Conflict of interest

Isao Yokota received speaking fees from Chugai Pharmaceutical. None of other authors have a potential conflict of interest.

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Miyake, M., Matsuyama, H., Teramukai, S. et al. A new risk stratification model for intravesical recurrence, disease progression, and cancer-specific death in patients with non-muscle invasive bladder cancer: the J-NICE risk tables. Int J Clin Oncol 25, 1364–1376 (2020). https://doi.org/10.1007/s10147-020-01654-5

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  • DOI: https://doi.org/10.1007/s10147-020-01654-5

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