Use and Validation of the AUA/SUO Risk Grouping for Nonmuscle Invasive Bladder Cancer in a Contemporary Cohort

Abstract

Purpose: To apply non-muscle invasive bladder cancer (NMIBC) AUA/SUO guidelines for risk-stratification and analyze predictors of recurrence and progression. Methods: Retrospective review of 398 patients with NMIBC treated between 2001 and 2017. Descriptive statistics were used to compare AUA/SUO risk-groups. Predictors of recurrence and progression were determined by multivariable regression. Kaplan Meier analysis, Cox proportional hazards regression model and time-dependent AUC was performed to determine progression-free and recurrence-free survival by risk-group. Results: Median follow-up was 37-months (95% CI: 35- to 42-months). 92% of patients underwent BCG induction and 46% of patients received at least 1 course of maintenance treatment. There were 11.5% low-risk, 32.5% intermediate-risk and 55.8% high-risk patients. The 5-year progression-free survival (PFS) and recurrence-free survival (RFS) for low-, intermediate- and high-risk patients was 93%, 74% and 54% and 43%, 33% and 23%, respectively. On Kaplan Meier analysis, HG Ta ≤3cm RFS and PFS stratified between intermediate and high-risk group. Relative to low-risk, classification as intermediate- or high-risk was an independent predictor of progression (HR: 9.7, CI: 2.23–42.0, p<0.01 and HR: 36, CI: 8.16–159, p<0.001, respectively). High-risk patients were more likely to recur relative to low-risk patients (HR: 2.03, CI: 1.11–3.71, p=0.022). For recurrence and progression, 1 year AUC values were 0.60 (CI: 0.546–0.656) and 0.68 (CI: 0.622–0.732), respectively. Conclusions: The AUA/SUO NMIBC risk-classification system appropriately stratifies patients based on likelihood of recurrence and progression and should be used at the time of diagnosis to counsel patients and guide therapy.