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OBJECTIVE: To construct predictive models based on the objectively calculated risks of progression and recurrence of non-muscle-invasive bladder cancer (NMIBC) in a large cohort of patients from a single centre. PATIENTS AND METHODS: Between October 1984 and March 2009 a cohort of 1019 patients (877 males; 142 females; median age 44 years) with histologically confirmed NMIBC was included in this study. Among these patients, 74% received bacillus Calmette-Guérin (BCG)-based therapy. Complete transurethral resection of bladder tumour of all visible tumours was carried out in all patients, and the stage and grade were determined. Univariate analysis and multivariate Cox regression were used to identify predictors of recurrence and progression. The studied predictors included age, sex, stage, grade, associated carcinoma in situ, tumour size, multiplicity, macroscopic appearance of the tumour, history of recurrence and type of adjuvant intravesical therapy. Multivariate logistic regression models were used to develop the 12- and 60-month recurrence and progression predictive models. The predictive accuracy of the models was assessed for discrimination as well as calibration. RESULTS: The median (range) follow-up was 44 (6-254) months. On multivariate analysis, stage, multiplicity, history of recurrence and adjuvant intravesical therapy were significantly associated with recurrence, whereas for progression only tumour grade and size were significant independent predictors. The constructed nomograms had a 64.9% and 69.4% chance of correctly distinguishing between two patients, one destined to have a recurrence and one not at 12 and 60 months, respectively. The constructed nomograms had a 70.2% and 73.5% chance of correctly distinguishing between two patients, one destined to progress and one not at 12 and 60 months, respectively. All predictive models were well calibrated. CONCLUSIONS: Based on multivariate analysis of the studied prognostic factors nomograms for predicting recurrence and progression in NMIBC were constructed. Most of the studied patients had received BCG-based therapy, making these models more closely applicable to contemporary practice than others. These predictive models have reasonable discriminative ability and are well calibrated, but require external validation before they can be applied to other populations.

OBJECTIVE: To construct predictive models based on the objectively calculated risks of progression and recurrence of non-muscle-invasive bladder cancer (NMIBC) in a large cohort of patients from a single centre. PATIENTS AND METHODS: Between October 1984 and March 2009 a cohort of 1019 patients (877 males; 142 females; median age 44 years) with histologically confirmed NMIBC was included in this study. Among these patients, 74% received bacillus Calmette-Guérin (BCG)-based therapy. Complete transurethral resection of bladder tumour of all visible tumours was carried out in all patients, and the stage and grade were determined. Univariate analysis and multivariate Cox regression were used to identify predictors of recurrence and progression. The studied predictors included age, sex, stage, grade, associated carcinoma in situ, tumour size, multiplicity, macroscopic appearance of the tumour, history of recurrence and type of adjuvant intravesical therapy. Multivariate logistic regression models were used to develop the 12- and 60-month recurrence and progression predictive models. The predictive accuracy of the models was assessed for discrimination as well as calibration. RESULTS: The median (range) follow-up was 44 (6-254) months. On multivariate analysis, stage, multiplicity, history of recurrence and adjuvant intravesical therapy were significantly associated with recurrence, whereas for progression only tumour grade and size were significant independent predictors. The constructed nomograms had a 64.9% and 69.4% chance of correctly distinguishing between two patients, one destined to have a recurrence and one not at 12 and 60 months, respectively. The constructed nomograms had a 70.2% and 73.5% chance of correctly distinguishing between two patients, one destined to progress and one not at 12 and 60 months, respectively. All predictive models were well calibrated. CONCLUSIONS: Based on multivariate analysis of the studied prognostic factors nomograms for predicting recurrence and progression in NMIBC were constructed. Most of the studied patients had received BCG-based therapy, making these models more closely applicable to contemporary practice than others. These predictive models have reasonable discriminative ability and are well calibrated, but require external validation before they can be applied to other populations.

Objectives: To present an update of our experience with sequential immuno-chemotherapy using bacillus Calmette-Guerin (BCG) and epirubicin in superficial bladder tumors. In addition, the question of whether to start with BCG or epirubicin is answered. Methods: Between January 1993 and December 2001, 156 patients with histologically proven Ta and T1 bladder transitional cell carcinoma were included in a prospective randomized study. Following transurethral resection of the bladder tumor (TURBT), patients were randomly assigned to 1 of 2 groups. Patients in group 1 received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly dose of BCG alternating with epirubicin, to complete 1 year of treatment. Patients in group 2 received the same protocol, but with a reversed order with epirubicin being used initially. Results: 149 patients, 114 men and 35 women with a mean age of 55 years, were evaluable. 7 patients were excluded due to severe side effects. Mean and median follow-up was 42.8 and 43 months, respectively. In the whole series recurrence rate was 18.1%, recurrence rate per year was 0.06, mean interval to first recurrence was 29 months and progression rate was 12%. Side effects developed in 40 patients (25.6%) and were mostly in the form of mild cystitis (26 patients). The 2 groups of therapy were comparable regarding recurrence rate, recurrence rate per year, progression rate and side effects. Conclusions: The sequential therapy is effective in recurrence prophylaxis of superficial bladder tumors. The side effects were less frequent than in our historical controls treated with BCG alone. It does not matter to start with epirubicin or BCG in this regimen. L' Immunochimiothérapie Intravésicale Séquentielle pour Carcinoma à Cellules Transitionnelles Stades Ta et T1 de la Vessie: Une Mise à Jour Objectifs: Présenter une mise à jour de notre expérience en matière d'immuno-chimiothérapie séquentielle utilisant le bacille de Calmette-Guerin (BCG) et l'Epirubicin dans les tumeurs superficielles de vessie. En outre, la question de commencer par BCG ou epirubicin est traitée. Méthodes: Entre janvier 1993 et décembre 2001, 156 patients présentant un carcinome à cellules transitionnelles de la vessie au stade pTa et pT1 histologiquement prouvé ont été inclus dans une étude randomisée. Après la résection transurethrale de la tumeur de vessie (TURBT), des patients ont été aléatoirement affectés à 1 de 2 groupes. Les patients dans le groupe 1 ont reçu des doses hebdomadaires 150 mg de BCG alternant avec 50 mg d'epirubicin pendant 6 semaines. L'entretien a été effectué par des doses mensuelles de BCG alternant avec l'epirubicin, pendant 1 an de traitement. Les patients dans le groupe 2 ont reçu le même protocole, mais avec un ordre inversé avec l'epirubicin étant employé au début du traitement. Résultats: 149 patients, 114 hommes et 35 femmes présentant un âge moyen de 55 ans, étaient inclus dans l'étude. 7 patients étaient exclus à cause d'effets secondaires graves. Le suivi moyen et médian était de 42.8 et 43 mois, respectivement. Dans toute la série le taux de récidive était de 18.1%, le taux de récidive par an était de 0.06, l'intervalle moyen à la première récidive était de 29 mois et le taux de progression était de 12%. Les effets secondaires ont été constatés chez 40 patients (25.6%) dont la plupart étaient des cystites à minima (26 patients). Les 2 groupes étaient comparables concernant le taux de récidive, le taux de récidive par an, le taux de progression et les effets secondaires. Conclusions: La thérapie séquentielle est efficace dans la prophylaxie de récidive des tumeurs superficielles de vessie. Les effets secondaires étaient moins fréquents que dans nos précédentes séries traitées avec BCG seul. Il importe très peu de commencer par l'epirubicin ou le BCG dans ce protocole. African Journal of Urology Vol.9(3) 2003: 117-122