Performance of the EORTC and CUETO risk prediction models in contemporary patients undergoing transurethral resection of bladder tumor with blue light cystoscopy.

Background

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Objective

The European Organization for Research and Treatment of Cancer (EORTC) and the Club Urológico Español de Tratamiento Oncológico (CUETO) risk prediction models are established tools for predicting recurrence and progression in non-muscle invasive bladder cancer. However, their performance in patients undergoing TURBT with blue light cystoscopy (BLC-TURBT), which reduces disease recurrence, has not been examined. We, therefore, evaluated the performance of these models in a contemporary cohort of patients undergoing BLC-TURBT.

Methods

We identified patients aged 18 to 89 years in the multi-institutional Blue Light Cystoscopy with Cysview Registry who underwent BLC-TURBT between 2014 and 2023. We predicted disease recurrence- and progression-free survival estimates using the EORTC and CUETO models, and estimated observed recurrence-free (RFS) and progression-free (PFS) survival using the Kaplan-Meier method.

Results

A total of 899 patients were included. Tumor stage was Ta in 658 (73%) and T1 in 241 (27%) patients. EORTC risk score groups were associated with a statistically significant difference in RFS, whereas CUETO risk score groups were not. Observed RFS and PFS estimates were generally higher than that predicted by the EORTC risk score, while observed RFS and PFS were inconsistently related to that predicted by the CUETO risk score. The c-statistics for RFS and PFS by risk score group were 0.59 and 0.67 for EORTC, and 0.53 and 0.72 for CUETO, respectively.

Conclusions

In a contemporary cohort of patients undergoing BLC-TURBT, the EORTC and CUETO models demonstrated poor performance in predicting RFS and PFS. These results underscore the need for development of more accurate predictive models to guide the risk-adapted management of patients undergoing BLC-TURBT.