Improving Preoperative Treatment Plans in Bladder Cancer: Focus on Cystoscopic Parameters

By: Victoria Kuhr, BA
Posted: Monday, September 26, 2022

Qiang Lu, PhD, of The First Affiliated Hospital of Nanjing Medical University, China, and colleagues proposed that the cystoscopic parameters–based “JSPH” model” may accurately predict postoperative pathologic high-grade tumors prior to operations in patients with bladder cancer. Additionally, the study authors suggested better treatment plans may be based on preoperative grade prediction and stage prediction of high- and low-risk pathologic findings. These study findings were published in BMC Urology.

“Our predictive model may be used to alternate transurethral resection of bladder tumor to guide the surgical selection and potentially reduce anesthesia and operation risks, as well as the economic burden on patients,” said the study authors.

Recruited for the study were patients who had a cystoscopy biopsy for pathology and morphology evaluations between October 2010 and January 2021. The investigation tested for risk factors and diagnostic performance for high-grade bladder cancer.

A total of 366 patients were included in the study. Of these patients, 105 were recruited from January 2021 to July 2021 to validate the cystoscopic-based predictive model’s accuracy. Among the 105 patients, 57 had high-grade postoperative pathology. However, 63.1% (36 of 57) exhibited consistency between biopsy pathology and postoperative pathology. When the investigational model was incorporated into the validation, the accuracy of predicting postoperative high-grade pathology was 84.2% (48 of 57).

Overall, 261 of the 366 patients (71.3%) had a biopsy pathology grade that was consistent with postoperative pathology grade. However, 9.0% (33 of 336) of patients were pathologically downgraded, and 72.7% (24 of 33) of them were downgraded after the operation. Five cystoscopic parameters—tumor diameter, site, nonpedicled, high-grade biopsy pathology, and morphology—were associated with high-grade bladder cancer. The sensitivity and specificity of the five cystoscopic parameters were 86.2% and 84.0%, respectively. The consistency of preoperative and postoperative high-grade pathology was improved from a biopsy-based rate of 70.5% to the investigational model–based rate of 85.2%.

Disclosure: The study authors reported no conflicts of interest.

BMC Urology