Identifying Risk Factors in Patients With Non–Muscle-Invasive Bladder Cancer: Clinical Implications

Abstract

Diagnosis and surveillance of bladder cancer represents one of the most important clinical challenges in urologic practice. It is estimated that there are currently > 1 million men and women alive in the United States and Europe who have a history of bladder cancer. At the time of initial diagnosis, approximately 70% of patients have cancers confined to the epithelium or the subepithelial connective tissue. In general, these cancers are primarily managed by endoscopic resection. The dilemma in the management of non–muscle-invasive bladder cancer (NMIBC) is a high risk of recurrence ranging from30% up to nearly 80%; depending on the risk profile, up to 45% of tumors may progress to muscle-invasive disease within 5 yr after initial diagnosis [1]. Numerous phase 3 trials have confirmed that adjuvant intravesical therapy significantly decreases tumor recurrence; however, from the current data, it is evident that overtreatment is likely to occur in a significant proportion of these patients, causing unnecessary expense. Furthermore, because disease recurrence may occur even after several years, long-term surveillance of patients with NMIBC is necessary. Our current inability to manage patients with NMIBC based on their individual risk has contributed to the fact that bladder cancer has become one of the most expensive tumor entities. Keeping this in mind, the concept of risk-adapted surveillance of NMIBC has gained interest in recent years. Based on the course of the disease in well-controlled prospective randomized clinical trials, the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Club Urologico Espanol De Tratamiento Oncologico (CUETO) have developed risk tables to predict the individual risks for tumor recurrence or progression to muscle-invasivedisease [1,2]. It isofnote thatbothrisk tables