title: Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder.
abstract: BACKGROUND
  The European Organization for Research and Treatment of Cancer (EORTC) risk tables and the Spanish Urological Club for Oncological Treatment (CUETO) scoring model are the two best-established predictive tools to help decision making for patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the current study was to assess the performance of these predictive tools in a large multicentre cohort of NMIBC patients.
  
  
  METHODS
  We performed a retrospective analysis of 4689 patients with NMIBC. To evaluate the discrimination of the models, we created Cox proportional hazard regression models for time to disease recurrence and progression. We incorporated the patients calculated risk score as a predictor into both of these models and then calculated their discrimination (concordance indexes). We compared the concordance index of our models with the concordance index reported for the models.
  
  
  RESULTS
  With a median follow-up of 57 months, 2110 patients experienced disease recurrence and 591 patients experienced disease progression. Both tools exhibited a poor discrimination for disease recurrence and progression (0.597 and 0.662, and 0.523 and 0.616, respectively, for the EORTC and CUETO models). The EORTC tables overestimated the risk of disease recurrence and progression in high-risk patients. The discrimination of the EORTC tables was even lower in the subgroup of patients treated with BCG (0.554 and 0.576 for disease recurrence and progression, respectively). Conversely, the discrimination of the CUETO model increased in BCG-treated patients (0.597 and 0.645 for disease recurrence and progression, respectively). However, both models overestimated the risk of disease progression in high-risk patients.
  
  
  CONCLUSIONS
  The EORTC risk tables and the CUETO scoring system exhibit a poor discrimination for both disease recurrence and progression in NMIBC patients. These models overestimated the risk of disease recurrence and progression in high-risk patients. These overestimations remained in BCG-treated patients, especially for the EORTC tables. These results underline the need for improving our current predictive tools. However, our study is limited by its retrospective and multi-institutional design.
authors: 1] Department of Urology, Weill Cornell Medical College, New York, NY, USA [2] Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
authors: E
authors: E
authors: Xylinas
authors: M
authors: M
authors: Kent
authors: L
authors: L
authors: Kluth
authors: A
authors: A
authors: Pycha
authors: E
authors: E
authors: Comploj
authors: R S
authors: RS
authors: Svatek
authors: Y
authors: Y
authors: Lotan
authors: Q-D
authors: QD
authors: Trinh
authors: P I
authors: PI
authors: Karakiewicz
authors: S
authors: S
authors: Holmang
authors: D S
authors: DS
authors: Scherr
authors: M
authors: M
authors: Zerbib
authors: A J
authors: AJ
authors: Vickers
authors: S F
authors: SF
authors: Shariat
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology*; D019459:Urothelium / Q000473:pathology
references: Eur Urol. 2010 Sep;58(3):433-41
references: 20646825
references: Eur Urol. 2013 Jan;63(1):36-44
references: 22981672
references: Curr Opin Urol. 2008 Sep;18(5):488-92
references: 18670272
references: Eur Urol. 2012 Apr;61(4):854-5
references: 22226583
references: Eur Urol. 2011 Sep;60(3):423-30
references: 21621906
references: Eur Urol. 2006 Mar;49(3):466-5; discussion 475-7
references: 16442208
references: J Urol. 2002 Nov;168(5):1964-70
references: 12394686
references: BJU Int. 2009 Feb;103(4):475-9
references: 18990174
references: World J Urol. 2011 Aug;29(4):409-14
references: 21190023
references: CA Cancer J Clin. 2013 Jan;63(1):11-30
references: 23335087
references: J Urol. 2009 Nov;182(5):2195-203
references: 19758621
references: Eur Urol. 2011 Jun;59(6):997-1008
references: 21458150
references: Eur Urol. 2009 Aug;56(2):247-56
references: 19409692
references: BJU Int. 2004 Mar;93(4):485-90
references: 15008714
references: Korean J Urol. 2010 Mar;51(3):165-70
references: 20414391
references: Urology. 2004 Apr;63(4):682-6; discussion 686-7
references: 15072879
references: J Urol. 2008 Nov;180(5):1928-32; discussion 1932
references: 18801529
references: J Urol. 1996 Aug;156(2 Pt 1):372-6
references: 8683682