Prognostic factors in non-muscle-invasive bladder tumors - I. Clinical prognostic factors: A review of the experience of the EORTC genito-urinary group - II. Biologic prognostic markers

Objectives: To summarize the most important clinical prognostic factors of non-muscle-invasive bladder cancer, as assessed by the European organization for Research and Treatment of Cancer (EORTC) Genito-Urinary Group, to present biologic markers involved in urothelial cell carcinoma, and to address their prognostic value. Methods: On three occasions between 1983 and 2006, prognostic factors were assessed based on individual patient data. Patients were included in one (308 patients), two (576 patients), or seven (2596 patients) EORTC trials. The literature on biologic markers for superficial bladder cancer was reviewed and screened for prognostic factors with independent predictive value. Results: Multivariate statistical techniques revealed that number of tumors, prior recurrence rate, tumor size, and G grade were the most important prognostic factors for recurrence. For invasion tumor grade, recurrence rate at entry, and size of the tumor determined prognosis. An index was computed reflecting the risk for invasion. From the combined analysis of seven EORTC trials, a scoring system was developed based on six factors: number of tumors, tumor size, prior recurrence rate, T category, carcinoma in situ, and grade. The probabilities of recurrence and progression ranged at 5 yr from 31% to 78% and from <1% to 45%. Markers that characterize the histology and cellular appearance of a tumor may predict disease recurrence, but they are not ready for use in daily decision-making. Conclusion: Urologists can discuss treatment options with patients after using this scoring system to calculate the probabilities of recurrence and progression. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved