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Thomas Flaig, MD
Thomas Flaig, MD
Posted: Tuesday, May 30, 2023
Optimizing surveillance protocols may improve surveillance costs after transurethral resection of bladder tumors for patients with high-risk non–muscle-invasive bladder cancer, according to a presentation given at the American Urological Association (AUA) Annual Meeting 2023 (Abstract MP08-02) and published in The Journal of Urology. According to Chikara Ohyama, MD, PhD, of Hirosaki University Graduate School of Medicine, Japan, and colleagues, “the aim of the present study was to develop optimized surveillance protocols based on the risk score–based substratifications to improve surveillance costs.”
The retrospective study evaluated 428 patients with high-risk non–muscle-invasive bladder cancer who had undergone transurethral resection. The investigators used multivariate analysis to account for independent risk factors and upper urinary tract recurrences. Patients were then stratified into lower-, intermediate-, and higher-risk groups for both intravesical and upper urinary tract recurrences by taking the sum of the independent risk factors. The group optimized surveillance protocols by using the real incidences of recurrence after transurethral resection.
The median follow-up period was 54 months. Multivariate analysis revealed chronic kidney disease, a tumor of grade 3, and a tumor size greater than 30 mm were all independently associated with upper urinary tract recurrence. When the authors conducted a Kaplan-Meier analysis, the curves demonstrated that upper urinary tract recurrence and intravesical recurrence-free survival could be successfully separated by lower-, intermediate-, and higher-risk groups. Intravesical risk classification occurred in 42% of patients in the lower-risk group, 37% of the intermediate-risk group, and 21% of the higher-risk group. For upper urinary tract recurrence risk, 49% of patients were classified as lower risk; 40%, as intermediate risk; and 11%, as higher risk. Lastly, the team reported that optimized surveillance protocols demonstrated a 43% reduction in the 10-year total surveillance cost when compared with the European Association of Urology guidelines.
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