MP5-03 ADHERENCE AND ADEQUACY OF THE BLADDER CANCER GUIDELINES FOR POST-TUR FOLLOW-UP INTERVAL

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-03 ADHERENCE AND ADEQUACY OF THE BLADDER CANCER GUIDELINES FOR POST-TUR FOLLOW-UP INTERVAL Takuro Sunada, Takashi Kobayashi, Yoshiyuki Matsui, Takahiro Inoue, Tomomi Kamba, and Osamu Ogawa Takuro SunadaTakuro Sunada More articles by this author , Takashi KobayashiTakashi Kobayashi More articles by this author , Yoshiyuki MatsuiYoshiyuki Matsui More articles by this author , Takahiro InoueTakahiro Inoue More articles by this author , Tomomi KambaTomomi Kamba More articles by this author , and Osamu OgawaOsamu Ogawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.230AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For non-muscle-invasive bladder cancer (NMIBC), currently available guidelines recommend various follow-up intervals for post-transurethral resection (TUR) cystoscopy (CS). All major guidelines including EAU, NCCN, AUA, and JUA uniformly recommend that first post-TUR CS be done at 3 months. In recurrence-free cases at 3 months, however, EAU/NCCN guidelines recommend performing CS at longer intervals thereafter depending on recurrence risk, while AUA/JUA guidelines recommend CS every 3 months for all cases. The aim of this study is to evaluate the adherence, adequacy, safety and cost of each follow-up protocol. METHODS We retrospectively reviewed 423 patients with NMIBC who underwent TUR-BT between 2008 and 2013. Median (range) follow-up was 32.6 (0.5 – 76.6) months. Our post-TUR follow-up protocol comprised CS at every 3 months for all patients at any risk. We categorized post-TUR recurrent tumors into interval tumors and regular tumors; the former were those detected by CS that would not have been scheduled with NCCN guideline (at 6, 12, 18 and 24 months postoperatively), while the latter were the others detected by CS that would have been done with any guideline (at 9, 15, 21 and 27 months postoperatively). RESULTS According to EORTC criteria, 45 (10.6%), 295 (69.7%), and 83 (19.6%) patients were stratified into low, intermediate and high risk group, respectively. CS adherence rate at 3 months was 92.7% while throughout the study period adherence for NCCN and AUA guidelines were 92.1% and 81.6%, respectively. There was no CS-associated complication of Clavien-Dindo grade 3 or more. There were 58 cases who developed intravesical recurrence; 29 were interval tumors while the remaining 29 were categorized in regular group (Table). If we had followed NCCN guideline, we could have decreased the number of CS by 2.55 times and reduced medical cost by US$244 per patient in the first 2 years. CONCLUSIONS The adherence was satisfactorily high and most of interval cancers were clinicopathologically favorable. Follow up interval can be safely extended for EORTC non-high risk patients, particularly for those with EORTC recurrence score 0–4, which will significantly save patients' bother, medical resources and costs. Clinicopathological characteristics of interval and regular tumors at recurrence Interval group (n = 29) Regular group (n = 29) P value EORTC recurrence risk N.S. 1-4 8 (27.6%) 11 (37.9%) 5-10 21 (72.4%) 18 (61.1%) EORTC progression risk N.S. 0 6 (20.7%) 7 (24.1%) 2-6 18 (62.1%) 20 (68.9%) 7-13 4 (13.8%) 2 (6.9%) 14-23 1 (3.4%) 0 (0%) pT stage N.S. pTx 5 (17.2%) 3 (10.2%) pTis 3 (10.3%) 2 (6.9%) PTa 20 (68.9%) 23 (79.3%) pT1 1 (3.4%) 1 (3.4%) N.S. Grade Low 24 (82.8%) 23 (79.3%) High 5 (17.2%) 6 (20.7%) N.S. Urine cytology Positive 4 (13.8%) 3 (10.3%) Negative 25 (86.3%) 26 (89.7%) N.S. Tumor size < 3 cm 24 (82.8%) 24 (82.8%) ≥ 3 cm 5 (17.2%) 5 (17.2%) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e45-e46 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takuro Sunada More articles by this author Takashi Kobayashi More articles by this author Yoshiyuki Matsui More articles by this author Takahiro Inoue More articles by this author Tomomi Kamba More articles by this author Osamu Ogawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...