title: EORTC Risk Model to Predict Progression in Patients With Non-Muscle-Invasive Bladder Cancer: Is It Safe to Use in Clinical Practice?
abstract: OBJECTIVE
  To evaluate the validation of European Organization for Research and Treatment of Cancer (EORTC) risk tables to predict progression in Brazilian patients with non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  Two hundred five consecutively and prospectively selected patients with NMIBC who underwent transurethral resection were analyzed during 12 years. Six parameters were analyzed: tumor grade, size, and number, pT stage, previous recurrence rate, and carcinoma-in-situ. Time to progression, risk score, and progression probabilities were calculated and compared to probabilities obtained from the EORTC model. The C index was calculated, and accuracy was analyzed for external validation.
  
  
  RESULTS
  A total of 152 patients had complete follow-up data, 36 died, and 17 were lost to follow-up. One hundred thirty-seven patients had primary tumors and 68 had recurrent tumors. Progression to muscle-invasive disease occurred in 42 patients (20.5%). Significant characteristics related to progression were male gender, pT1 stage, lesion size ≥ 3 cm, high grade of disease, and no combined intravesical therapy. Mean time to progression was 26.9 months; the 1-year progression rate was 3.4% and the 5-year rate was 19.1%. The C index was 0.86 at 1 year and 0.78 at 5 years. For calibration, 1- and 5-year progression rates were lower than the values predicted by EORTC risk tables, mainly in high-risk groups. Although the EORTC model overestimated the short- and long-term risk of progression, an overlapping of the confidence intervals between both populations was detected.
  
  
  CONCLUSIONS
  The EORTC model successfully stratified progression risks in a Brazilian cohort, although it overestimated progression rates. This scoring system is useful in predicting progression of NMIBC; however, updating new risk markers is essential to improve risk classification and prediction of progression.
authors.affiliation: University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil.
authors.forename: Wilson F S
authors.initials: WF
authors.lastname: Busato Júnior
authors.affiliation: University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil; Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil. Electronic address: glalmeida@ibest.com.br.
authors.forename: Gilberto Laurino
authors.initials: GL
authors.lastname: Almeida
authors.affiliation: Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil.
authors.forename: Carmen A P M
authors.initials: CA
authors.lastname: Ribas
authors.affiliation: Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil.
authors.forename: Jurandir M
authors.initials: JM
authors.lastname: Ribas Filho
authors.affiliation: University of Milan, Milan, Italy; Department of Urology, European Institute of Oncology (IEO), Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
mesh_terms: D000368:Aged; D001938:Brazil; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
keywords: Non–muscle-invasive bladder cancer; Prediction; Progression; Recurrence; Validation