Comparison of expected treatment outcome provided by risk models and international guidelines with observed treatment outcome in a cohort of Dutch non-muscle-invasive bladder cancer patients treated with intravesical chemotherapy
Lammers RJ, Palou J, Witjes WP, Janzing-Pastors MH, Caris CT, Witjes JA. BJU Int. 2013 Oct 15. doi: 10.1111/bju.12495. [Epub ahead of print]

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Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, the Netherlands.


OBJECTIVE: To compare the risks provided by AUA, EAU, EORTC and CUETO classifications with the real outcome in Dutch patients, and to confirm that undertreated patients do have worse outcome than adequately-treated patients.

PATIENTS AND METHODS: Dutch patients treated with complete TURBT and intravesical chemotherapy were included. Nowadays, not all patients would have received intravesical chemotherapy, and thus comparison of observed outcome of Dutch patients versus expected outcome based on the EORTC risk tables and CUETO scoring model was possible. Furthermore, the Dutch cohort was reclassified according to the definitions of five Index patients (IPs) ( AUA-guideline) and three risk groups (EAU-guideline) to compare the outcome of undertreated patients with adequately-treated patients.

RESULTS: A total of 1001 patients were available for comparison with the AUA-guideline; 728 patients were available for comparison with the EORTC and CUETO models. There was much overlap between the observed and expected recurrence and progression probabilities when comparing with the EORTC risk tables. The observed recurrence outcome were in general higher than the expected CUETO probabilities, especially on the long term. No differences in progression were found. Patients that were undertreated according to the guidelines showed in general an increased chance of developing recurrences and progression. Limitations are i.a. its retrospective nature and the differences in grading system.

CONCLUSION: Comparison between the observed outcome in Dutch patients and the expected outcome based on EAU- and CUETO risk models and the European and American guidelines showed that the lack of adherence to existing guidelines translates into worse outcome.