Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder

E Xylinas, M Kent, L Kluth, A Pycha, E Comploj, R S Svatek, Y Lotan, Q-D Trinh, P I Karakiewicz, S Holmang, D S Scherr, M Zerbib, A J Vickers, S F Shariat, E Xylinas, M Kent, L Kluth, A Pycha, E Comploj, R S Svatek, Y Lotan, Q-D Trinh, P I Karakiewicz, S Holmang, D S Scherr, M Zerbib, A J Vickers, S F Shariat

Abstract

Background: The European Organization for Research and Treatment of Cancer (EORTC) risk tables and the Spanish Urological Club for Oncological Treatment (CUETO) scoring model are the two best-established predictive tools to help decision making for patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the current study was to assess the performance of these predictive tools in a large multicentre cohort of NMIBC patients.

Methods: We performed a retrospective analysis of 4689 patients with NMIBC. To evaluate the discrimination of the models, we created Cox proportional hazard regression models for time to disease recurrence and progression. We incorporated the patients calculated risk score as a predictor into both of these models and then calculated their discrimination (concordance indexes). We compared the concordance index of our models with the concordance index reported for the models.

Results: With a median follow-up of 57 months, 2110 patients experienced disease recurrence and 591 patients experienced disease progression. Both tools exhibited a poor discrimination for disease recurrence and progression (0.597 and 0.662, and 0.523 and 0.616, respectively, for the EORTC and CUETO models). The EORTC tables overestimated the risk of disease recurrence and progression in high-risk patients. The discrimination of the EORTC tables was even lower in the subgroup of patients treated with BCG (0.554 and 0.576 for disease recurrence and progression, respectively). Conversely, the discrimination of the CUETO model increased in BCG-treated patients (0.597 and 0.645 for disease recurrence and progression, respectively). However, both models overestimated the risk of disease progression in high-risk patients.

Conclusion: The EORTC risk tables and the CUETO scoring system exhibit a poor discrimination for both disease recurrence and progression in NMIBC patients. These models overestimated the risk of disease recurrence and progression in high-risk patients. These overestimations remained in BCG-treated patients, especially for the EORTC tables. These results underline the need for improving our current predictive tools. However, our study is limited by its retrospective and multi-institutional design.

Figures

Figure 1
Figure 1
(A–D) Calibration plots for the EORTC model in the entire cohort of 4689 patients with non-muscle-invasive urothelial carcinoma of the bladder (Grey – EORTC risk, Black – actual risk). (A) One-year risk of recurrence. (B) Five-year risk of recurrence. (C) One-year risk of progression. (D) Five-year risk of progression.
Figure 2
Figure 2
(A–D) Calibration plots for the CUETO model in the entire cohort of 4689 patients with non-muscle-invasive urothelial carcinoma of the bladder (Grey – CUETO risk; Black – actual risk). (A) One-year risk of recurrence. (B) Five-year risk of recurrence. (C) One-year risk of progression. (D) Five-year risk of progression.
Figure 3
Figure 3
(A–D) Calibration plots for the EORTC model in 538 patients with non-muscle-invasive urothelial carcinoma of the bladder treated with BCG (Grey – EORTC risk; Black – actual risk). (A) One-year risk of recurrence. (B) Five-year risk of recurrence. (C) One-year risk of progression. (D) Five-year risk of progression.
Figure 4
Figure 4
(A–D) Calibration plots for the CUETO model in 538 patients with non-muscle-invasive urothelial carcinoma of the bladder treated with BCG (Grey – CUETO risk; Black – actual risk). (A) One-year risk of recurrence. (B) Five-year risk of recurrence. (C) One-year risk of progression. (D) Five-year risk of progression.

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