FGFR3 mutation analysis on voided urine samples to reduce cystoscopies and cost in non-muscle invasive bladder cancer surveillance: a comparison of three different strategies
van Kessel KE, Kompier LC, de Bekker-Grob EW, Zuiverloon TC, Vergouwe Y, Zwarthoff EC, Steyerberg EW. J Urol. 2012 Nov 6. pii: S0022-5347(12)05470-5. doi: 10.1016/j.juro.2012.11.005. [Epub ahead of print]


Department of Public Health, Erasmus MC, Rotterdam, Netherlands.



To determine if FGFR3 mutation analysis on voided urine samples is cost-effective to partly replace cystoscopy in surveillance of patients treated for non muscle invasive urothelial carcinoma (UC).


Decision analytic study. As input we analyzed data from 70 Dutch patients with FGFR3 positive primary tumors and a median follow-up of 8.8 years. Surveillance strategies were compared in a Markov model. Modified surveillance consisted of FGFR3 mutation analysis on voided urine samples every three months and cystoscopy at 3, 12 and 24 months. Standard surveillance of a cystoscopy every 3 months and minimal surveillance of a cystoscopy at 3, 12 and 24 months. Analyses were stratified for three risk profiles (surveillance after the primary tumor, the first to third recurrence, and fourth recurrence or more). Sensitivity analyses were performed to evaluate the impact of variation in costs, sensitivities and specificities.


The probability of being without recurrence after two years of surveillance after a primary tumor was higher for modified surveillance compared to standard and minimal surveillance, e.g. after primary tumors, 95.7% vs. 95.0% vs. 93.9%. The total cost of surveillance after the primary tumor was lower for minimal and modified surveillance (€2,254 and €2,558 respectively) than standard surveillance (€5,861). Results were robust to changing inputs over plausible ranges, and consistent for each of the three risk profiles.


Surveillance in which cystoscopy is partly replaced by FGFR3 mutation analysis on urine seems a safe and (cost)effective surveillance strategy. Further validation in larger cohorts is required.