Towards Defining Follow-up Strategies for Patients with Primary Intermediate-risk Non-muscle-invasive Bladder Cancer
Por:
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
Publicada:
1 sep 2025
Ahead of Print:
1 sep 2025
Resumen:
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.
Filiaciones:
Contieri, R:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Human Univ, Dept Biochem Sci, Milan, Italy
Human Clin & Res Inst IRCCS, Dept Urol, Rozzano, Italy
Martini, A:
Univ Cincinnati, Dept Urol, Cincinnati, OH USA
Beijert, IJ:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Vrije Univ, Amsterdam Univ Med Ctr, Dept Urol, Amsterdam, Netherlands
Mertens, LS:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Hentschel, AE:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Vrije Univ, Amsterdam Univ Med Ctr, Dept Urol, Amsterdam, Netherlands
Brundl, J:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Compérat, EM:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Sorbonne Univ, Tenon Hosp, Dept Pathol, AP HP, Paris, France
Plass, K:
European Assoc, Urol Guidelines Off, Arnhem, Netherlands
Rodríguez, O:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Henríquez, JDS:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Hernández, V:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
de la Pena, E:
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
Alemany, I:
Hosp Univ Fdn Alcorcon, Dept Pathol, Madrid, Spain
Turturica, D:
Univ Torino, Dept Urol Citta Salute & Sci, Sch Med, Turin, Italy
Pisano, F:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Univ Torino, Dept Urol Citta Salute & Sci, Sch Med, Turin, Italy
Soria, F:
Univ Torino, Dept Urol Citta Salute & Sci, Sch Med, Turin, Italy
Capoun, O:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Charles Univ Praha, Dept Urol Gen, Teaching Hosp, Prague, Czech Republic
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Bauerova, L:
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Charles Univ Praha, Gen Teaching Hosp, Dept Pathol, Prague, Czech Republic
Pesl, M:
Charles Univ Praha, Dept Urol Gen, Teaching Hosp, Prague, Czech Republic
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Bruins, HM:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Runneboom, W:
Radboud Univ Nijmegen, Med Ctr, Dept Pathol, Nijmegen, Netherlands
Herdegen, S:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Breyer, J:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Brisuda, A:
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Charles Univ Praha, Teaching Hosp Motol, Dept Urol, Prague, Czech Republic
Calatrava, A:
Fdn Inst Valenciano Oncol, Dept Pathol, Valencia, Spain
Rubio-Briones, J:
Fdn Inst Valenciano Oncol, Dept Urol, Valencia, Spain
Seles, M:
Med Univ Graz, Dept Urol, Graz, Austria
Mannweiler, S:
Med Univ Graz, Dept Pathol, Graz, Austria
Bosschieter, J:
Vrije Univ, Amsterdam Univ Med Ctr, Dept Urol, Amsterdam, Netherlands
Kusuma, VRM:
Royal Surrey Hosp, Stokes Ctr Urol, Dept Urol, Guildford, England
Ashabere, D:
Royal Surrey Hosp, Stokes Ctr Urol, Dept Urol, Guildford, England
Huebner, N:
Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Seisen, T:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Sorbonne Univ, Pitie Salpetriere Hosp, Dept Urol, AP HP,GRC 5 ONCOTYPE URO, Paris, France
Claps, F:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Masson-Lecomte, A:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Paris Cite Univ, St Louis Hosp, AP HP, Dept Urol, Paris, France
Liedberg, F:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Skaanes Universitetssjukhus, Dept Urol, Malmo, Sweden
Cohen, D:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Royal Free London NHS Fdn Trust, Dept Urol, London, England
Lunelli, L:
Sorbonne Univ, Tenon Hosp, Dept Urol, AP HP, Paris, France
Cussenot, O:
Sorbonne Univ, Tenon Hosp, Dept Urol, AP HP, Paris, France
El Sheikh, S:
Royal Free London NHS Fdn Trust, Dept Pathol, London, England
Volanis, D:
Royal Free London NHS Fdn Trust, Dept Urol, London, England
Roupret, M:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Sorbonne Univ, Pitie Salpetriere Hosp, Dept Urol, AP HP,GRC 5 ONCOTYPE URO, Paris, France
Shariat, SF:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Charles Univ Praha, Teaching Hosp Motol, Dept Urol, Prague, Czech Republic
Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Mostafid, AH:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Royal Surrey Hosp, Stokes Ctr Urol, Dept Urol, Guildford, England
Nieuwenhuijzen, JA:
Vrije Univ, Amsterdam Univ Med Ctr, Dept Urol, Amsterdam, Netherlands
Zigeuner, R:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Med Univ Graz, Dept Urol, Graz, Austria
Dominguez-Escrig, JL:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Fdn Inst Valenciano Oncol, Dept Urol, Valencia, Spain
Burger, M:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
van de Kaa, CA:
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Charles Univ Praha, Teaching Hosp Motol, Dept Urol, Prague, Czech Republic
van der Heijden, AG:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Soukup, V:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Charles Univ Praha, Dept Urol Gen, Teaching Hosp, Prague, Czech Republic
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Hurle, R:
Human Clin & Res Inst IRCCS, Dept Urol, Rozzano, Italy
Paciotti, M:
Human Univ, Dept Biochem Sci, Milan, Italy
Human Clin & Res Inst IRCCS, Dept Urol, Rozzano, Italy
Charles Univ Praha, Fac Med 1, Prague, Czech Republic
Gontero, P:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Univ Torino, Dept Urol Citta Salute & Sci, Sch Med, Turin, Italy
Llorente, C:
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
Palou, J:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
N'Dow, J:
European Assoc, Urol Guidelines Off, Arnhem, Netherlands
Ribal, MJ:
European Assoc, Urol Guidelines Off, Arnhem, Netherlands
Babjuk, M:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
Charles Univ Praha, Teaching Hosp Motol, Dept Urol, Prague, Czech Republic
Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Sylvester, RJ:
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
van Rhijn, BWG:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
European Assoc Urol, Nonmuscle Invas Bladder Canc Guidelines Panel, Arnhem, Netherlands
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