Risk-Based Substratification Improves Surveillance Costs for Patients With HR-NMIBC

New research presented at the American Urological Association 2023 Annual Meeting sought to define optimized surveillance protocols based on risk score-based substratifications to improve surveillance costs.

A group of 428 patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) who underwent transurethral resection of the bladder (TURBT) from November 1993 to April 2019 were retrospectively evaluated. Independent risk factors for intravesical and upper urinary tract (UUT) recurrences were assessed by multivariable analyses.

Surveillance protocols to enhance cost-effectiveness were developed using existing data of real incidences of recurrence after TURBT. The 10-year total surveillance costs were compared between the European Association of Urology (EAU) guidelines-based and optimized surveillance protocols.

The median patient age was 72 years, with follow-up at 54 months. Multivariable analyses found that chronic kidney disease, tumor sizes of 30 mm or more, and grade 3 disease were all contributing factors to intravesical and/or UUT recurrences.

A recurrence risk estimation was developed that substratified patients into separate groups. For the intravesical recurrence risk estimation, the groups were intra-lower (0 score), intra-intermediate (1 score), and intra-higher (2 or 3 scores). Groups were also created for the UUT recurrence risk estimation, which included UUT-lower (0 score), UUT-intermediate (1 score), and UUT-higher (2 scores). Patients were grouped by totaling their independent risk factors of intravesical and UUT recurrences.

The Kaplan-Meier curves of intravesical and UUT recurrence-free survival could be separated among each of the 3 groups. Optimized surveillance protocols promoted a 43% reduction in the 10-year total surveillance cost compared with the EAU guidelines-based surveillance protocol, demonstrating that updated protocols based on risk score-based grouping can improve surveillance costs after TURBT in patients with HR-NMIBC.