Korean J Urol.  2010 Mar;51(3):165-170.

The Efficacy of the EORTC Scoring System and Risk Tables for the Prediction of Recurrence and Progression of Non-Muscle-Invasive Bladder Cancer after Intravesical Bacillus Calmette-Guerin Instillation

• Seo KW
• Kim BH
• Park CH
• Kim CI
• Chang HS

Abstract

PURPOSE
The European Organization for Research and Treatment of Cancer (EORTC) scoring system and risk table were introduced in the 2008 European Association of Urology guidelines on TaT1 bladder cancer. We compared the recurrence and progression rate between EORTC risk tables and author's patients who underwent transurethral resection of bladder cancer (TURB) following intravesical Bacillus Calmette-Guerin (BCG) instillation. MATERIALS AND METHODS: The medical records of 251 patients who underwent TURB and were diagnosed with non-muscle-invasive bladder cancer from l993 to 2007 were analyzed. The patients were divided into 2 groups: the recurrence group and the progression group. According to the EORTC scoring system, the patients in each group were categorized in terms of number of tumors, tumor size, prior recurrence rate, T category, carcinoma in situ, and pathologic grade and the scores were summed. According to the summed scores, the recurrence group and the progression group were divided into 3 subgroups: low, intermediate, and high risk, respectively. The recurrence rate and progression rate of each group were compared with the EORTC risk tables. RESULTS: The recurrence rate and progression rate were almost similar to the EORTC risk tables. However, the recurrence rate was low in the intermediate-risk group. CONCLUSIONS: Clinical utilization of the EORTC scoring system and risk tables is very effective in predicting the recurrence and progression of non-muscle-invasive bladder cancer and in selecting treatment.

Keyword

Urinary bladder neoplasms; Recurrence; BCG vaccine

MeSH Terms

Bacillus
BCG Vaccine
Carcinoma in Situ
Humans
Medical Records
Recurrence
Urinary Bladder
Urinary Bladder Neoplasms
Urology
BCG Vaccine

Reference

1. Kim WJ, Chung JI, Hong JH, Kim CS, Jung SI, Yoon DK. Epidemiological study for urologic cancer in Korea (1998-2002). Korean J Urol. 2004. 45:1081–1088.

2. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006. 49:466–477.

3. Oosterlinck W, Lobel B, Jakse G, Malmström PU, Stöckle M, Sternberg C. Guidelines on bladder cancer. Eur Urol. 2002. 41:105–112.

4. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Palou J, Algaba F, Vicente-Rodriguez J. Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol. 2000. 164:680–684.

5. Kurth KH, Denis L, Bouffioux C, Sylvester R, Debruyne FM, Pavone-Macaluso M, et al. Factors affecting recurrence and progression in superficial bladder tumours. Eur J Cancer. 1995. 31A:1840–1846.

6. Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Palou J, Vicente-Rodriguez J. Multivariate analysis of the prognostic factors of primary superficial bladder cancer. J Urol. 2000. 163:73–78.

7. Solsona E, Iborra I, Dumont R, Rubio-Briones J, Casanova J, Almenar S. The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol. 2000. 164:685–689.

8. Kaasinen E, Rintala E, Hellström P, Viitanen J, Juusela H, Rajala P, et al. Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma. Eur Urol. 2002. 42:167–174.

9. Kwak C, Ku JH, Park JY, Lee E, Lee SE, Lee C. Initial tumor stage and grade as a predictive factor for recurrence in patients with stage T1 grade 3 bladder cancer. J Urol. 2004. 171:149–152.

10. Choi CK, Kim JS, Rim JS. Application of scoring system reflecting various prognostic factors to the prediction of recurrence in superficial bladder carcinoma. Korean J Urol. 1999. 40:878–885.

11. Kwak DY, Ha JY, Chang HS, Choi MS, Park CH, Kim CI. Clinical implications of the expression of survivin and p53 in superficial transitional cell carcinoma of the bladder. Korean J Urol. 2009. 50:12–17.

12. Maeng YH, Kang HW, Huh JS. The expression and clinical significance of the minichromosome maintenance (MCM) 7 proliferation markers in urothelial carcinomas of the bladder. Korean J Urol. 2008. 49:12–17.

13. Choi YD, Park JA, Cho NH, Yang WJ, Cho KS, Lee HY, et al. Expression of p53 and p73 genes in human transitional cell carcinoma of the bladder. Korean J Urol. 2004. 45:1209–1214.

14. Ha HK, Lee SD, Chung MK. The relationship between expression of hypoxia inducible factor-1α or vascular endothelial growth factor and histopathological characteristics in human transitional bladder cancer. Korean J Urol. 2004. 45:7–13.

15. Hinz S, Kempkensteffen C, Christoph F, Krause H, Schrader M, Schostak M, et al. Expression parameters of the polycomb group proteins BMI1, SUZ12, RING1 and CBX7 in urothelial carcinoma of the bladder and their prognostic relevance. Tumour Biol. 2008. 29:323–329.

16. Böhle A, Bock PR. Intravesical bacille Calmette-Guérin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology. 2004. 63:682–686.

17. Sylvester RJ, van der Meijden AP, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002. 168:1964–1970.

18. Dalbagni G. Is intravesical bacillus Calmette-Guérin better than mitomycin for intermediate-risk bladder cancer? Eur Urol. 2009. 56:257–258.

19. Malmström PU, Sylvester RJ, Crawford DE, Friedrich M, Krege S, Rintala E, et al. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer. Eur Urol. 2009. 56:247–256.

20. Böhle A, Jocham D, Bock PR. Intravesical bacillus Calmette-Guerin versus mitomycin C for superficial bladder cancer: a formal meta-analysis of comparative studies on recurrence and toxicity. J Urol. 2003. 169:90–95.

21. Cheng CW, Chan SF, Chan LW, Chan CK, Ng CF, Cheung HY, et al. Twelve-year follow up of a randomized prospective trial comparing bacillus Calmette-Guerin and epirubicin as adjuvant therapy in superficial bladder cancer. Int J Urol. 2005. 12:449–455.

22. Shelley MD, Wilt TJ, Court J, Coles B, Kynaston H, Mason MD. Intravesical bacillus Calmette-Guérin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int. 2004. 93:485–490.

23. Lundholm C, Norlén BJ, Ekman P, Jahnson S, Lagerkvist M, Lindeborg T, et al. A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. J Urol. 1996. 156:372–376.

24. Lamm DL. Efficacy and safety of bacille Calmette-Guérin immunotherapy in superficial bladder cancer. Clin Infect Dis. 2000. 31:Suppl 3. S86–S90.

25. Lamm DL, van der Meijden PM, Morales A, Brosman SA, Catalona WJ, Herr HW, et al. Incidence and treatment of complications of bacillus Calmette-Guérin intravesical therapy in superficial bladder cancer. J Urol. 1992. 147:596–600.