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The International Bladder Cancer Group’s intermediate-risk nonmuscle-invasive bladder cancer scoring system (IBCG IR-NMIBC) predicts the risk for subsequent transurethral resection of bladder tumor (TURBT) among patients with low-grade disease receiving active surveillance (AS).
“This collaboration study found that the IBCG IR-NMIBC scoring system predicts the likelihood of continued AS among patients in the BIAS study. As such, the scoring system can be used to counsel patients regarding the need for a delayed TURBT when embarking on an AS program,” Ashish M. Kamat, MBBS, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues wrote in The Journal of Urology.
The BIAS cohort included 163 patients with recurrent low-grade papillary Ta in 97.3% or T1a NMIBC in 3.7%, 5 or fewer apparent low-grade tumors at recurrence, tumor sized 1 cm or less in diameter, no gross hematuria, and no high-grade cells on urine cytology. After a median follow-up of 33 months, TURBT was performed in 109 patients.
The investigators assessed all patients for the presence of 5 risk factors defined by the IBCG IR-NMIBC scoring system: the presence of more than 1 multifocal tumor, early recurrence within 1 year, more than 1 early recurrence in a year, tumor size of 3 cm or larger, and failure of prior intravesical treatment.
At 24 months, patients with 0 risk factors were more than twice as likely to remain on AS compared with patients who had 3 or more risk factors (59% vs 24%), Dr Kamat’s team reported. AS duration was significantly longer for patients with 0 vs 1-2 and 3-5 risk factors: a median 28 months vs 25 and 15 months, respectively.
In multivariable Cox regression, TURBT risk was 1.6-fold higher for those with 1-2 risk factors and 3.2-fold higher for those with 3 or more risk factors, compared with patients with no risk factors. The model adjusted for age, sex, and T stage.
The upgrading rate was 6%. The investigators suggested further research should be done to further predict the overall risk of grade progression in patients on AS. The upstaging rate was 3%, but no patient developed MIBC.
Dr Kamat’s team stated, “We hope that as more data emerge, active surveillance would be incorporated into bladder cancer guidelines and that the urology community will embrace it as an option for selected IR NMIBC.”
In an accompanying editorial, Daniel R. Greenberg, MD, and Shilajit D. Kundu, MD, of Northwestern University Feinberg School of Medicine in Chicago, Illinois, commented:
“As we become more comfortable with monitoring indolent lesions in urological cancers, these data show that AS may be an option for [low-grade] bladder tumors as well. It avoids patient exposure to spinal or general anesthesia, limits time in the operating room, reduces postoperative complications, and decreases the cost of care for bladder cancer.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Shen Tan W, Contieri R, Buffi NM, et al. International bladder cancer group intermediate-risk nonmuscle-invasive bladder cancer scoring system predicts outcomes of patients on active surveillance. J Urol. Published online August 3, 2023. doi:10.1097/JU.0000000000003639
This article originally appeared on Renal and Urology News
