title: The EORTC tables overestimate the risk of recurrence and progression in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: external validation of the EORTC risk tables.
abstract: BACKGROUND
  European Organization for Research and Treatment of Cancer (EORTC) risk tables only included 171 patients treated with bacillus Calmette-Guérin (BCG) for non-muscle-invasive bladder cancer (NMIBC).
  
  
  OBJECTIVE
  To evaluate the external validity of the EORTC tables in patients with NMIBC treated with BCG over 5-6 mo.
  
  
  METHODS
  Data on 1062 patients treated with BCG were analyzed.
  
  
  METHODS
  Discrimination was assessed using the concordance index (c-index) and the prognostic separation index (PSEP). For calibration, probabilities of recurrence and progression obtained with the EORTC risk tables in our series were compared with those reported by the EORTC.
  
  
  CONCLUSIONS
  With respect to the discriminative ability of the EORTC model, c-index was similar to those reported in the EORTC series for recurrence. However, c-indices for progression in our series were lower than c-indices reported by Sylvester et al. [1]. Although PSEP in our series was lower than in the EORTC series for recurrence at 1 yr, similar results were found at 5 yr. Regarding progression, PSEP in our series was lower than in the EORTC series. Whilst a successful stratification of recurrence and progression probability at 1 and 5 yr was achieved using the EORTC tables in our series, model calibration showed lower risks of recurrence than those reported by Sylvester et al. [1] in all groups. For progression, lower risks were found in higher-risk groups. There are some limitations in the present study. A different distribution of patients was found, with higher proportions of primary grade 3 T1 tumors and tumors in situ than in the EORTC series. An additional limitation is that prior recurrence of the EORTC table was not included in our parameters. Consequently, two separate analyses were performed for recurrence.
  
  
  CONCLUSIONS
  The EORTC model successfully stratified recurrence and progression risks in our cohort. However, the discriminative ability of the EORTC tables decreased in our patients for progression. Moreover, these tables overestimated risks of recurrence and progression after BCG therapy.
authors.affiliation: Department of Urology, Hospital Central of Asturias, University of Oviedo, Oviedo, Spain. jmfernandezgomez23@gmail.com
authors.forename: Jesus
authors.initials: J
authors.lastname: Fernandez-Gomez
authors.forename: Rosario
authors.initials: R
authors.lastname: Madero
authors.forename: Eduardo
authors.initials: E
authors.lastname: Solsona
authors.forename: Miguel
authors.initials: M
authors.lastname: Unda
authors.forename: Luis
authors.initials: L
authors.lastname: Martinez-Piñeiro
authors.forename: Antonio
authors.initials: A
authors.lastname: Ojea
authors.forename: Jose
authors.initials: J
authors.lastname: Portillo
authors.forename: Manuel
authors.initials: M
authors.lastname: Montesinos
authors.forename: Marcelino
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Carlos
authors.initials: C
authors.lastname: Pertusa
authors.forename: Jesus
authors.initials: J
authors.lastname: Rodriguez-Molina
authors.forename: Jose Emilio
authors.initials: JE
authors.lastname: Camacho
authors.forename: Mariano
authors.initials: M
authors.lastname: Rabadan
authors.forename: Ander
authors.initials: A
authors.lastname: Astobieta
authors.forename: Santiago
authors.initials: S
authors.lastname: Isorna
authors.forename: Pedro
authors.initials: P
authors.lastname: Muntañola
authors.forename: Anabel
authors.initials: A
authors.lastname: Gimeno
authors.forename: Miguel
authors.initials: M
authors.lastname: Blas
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Martinez-Piñeiro
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000008:administration & dosage*; D016002:Discriminant Analysis; D018450:Disease Progression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine