title: Risk prediction scores for recurrence and progression of non-muscle invasive bladder cancer: an international validation in primary tumours.
abstract: OBJECTIVE
  We aimed to determine the validity of two risk scores for patients with non-muscle invasive bladder cancer in different European settings, in patients with primary tumours.
  
  
  METHODS
  We included 1,892 patients with primary stage Ta or T1 non-muscle invasive bladder cancer who underwent a transurethral resection in Spain (n = 973), the Netherlands (n = 639), or Denmark (n = 280). We evaluated recurrence-free survival and progression-free survival according to the European Organisation for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) risk scores for each patient and used the concordance index (c-index) to indicate discriminative ability.
  
  
  RESULTS
  The 3 cohorts were comparable according to age and sex, but patients from Denmark had a larger proportion of patients with the high stage and grade at diagnosis (p<0.01). At least one recurrence occurred in 839 (44%) patients and 258 (14%) patients had a progression during a median follow-up of 74 months. Patients from Denmark had the highest 10-year recurrence and progression rates (75% and 24%, respectively), whereas patients from Spain had the lowest rates (34% and 10%, respectively). The EORTC and CUETO risk scores both predicted progression better than recurrence with c-indices ranging from 0.72 to 0.82 while for recurrence, those ranged from 0.55 to 0.61.
  
  
  CONCLUSIONS
  The EORTC and CUETO risk scores can reasonably predict progression, while prediction of recurrence is more difficult. New prognostic markers are needed to better predict recurrence of tumours in primary non-muscle invasive bladder cancer patients.
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Moniek M
authors.initials: MM
authors.lastname: Vedder
authors.affiliation: Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
authors.forename: Mirari
authors.initials: M
authors.lastname: Márquez
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.affiliation: Systems Biology Department, University of Vic, Vic, Barcelona, Spain.
authors.forename: Malu L
authors.initials: ML
authors.lastname: Calle
authors.affiliation: Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Dyrskjøt
authors.affiliation: Centre for Research in Environmental Epidemiology, Municipal Institute of Medical Research, Barcelona, Spain.
authors.forename: Manoils
authors.initials: M
authors.lastname: Kogevinas
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Segersten
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.affiliation: Department of Pathology, Fundació Puigvert-University Autonomous, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Algaba
authors.affiliation: Department of Pathology, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Willemien
authors.initials: W
authors.lastname: Beukers
authors.affiliation: Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Torben F
authors.initials: TF
authors.lastname: Ørntoft
authors.affiliation: Department of Pathology, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Zwarthoff
authors.affiliation: Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
authors.affiliation: Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Malats
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D018450:Disease Progression; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D009361:Neoplasm Invasiveness; D012008:Recurrence; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000473:pathology*