1. EORTC scores of recurrence and progression in a Romanian cohort First author: Anda Ştefan Co-authors: Radu Mihail Boja, PhD Ovidiu Ioan Golea, PhD Ladislau Schwarts, PhD Sever Chiujdea Coordinators: Assistant Professor Mihai Vartolomei Associate Professor Orsolya Martha

2. Introduction  The European Organization for Research and Treatment of Cancer (EORTC) developed a scoring system and risk tables in order to predict the recurrence and progression in case of non-muscle- invasive bladder cancers (NMIBC);  The EORTC study was done in various countries, but it was never performed on a Romanian population.

3. Introduction and Objective  The term « progression» refers to the process of developing gradually towards a more advanced state (in our case towards a muscle invasive bladder cancer);  «Recurrence» means the return of a sign, symptom, or disease after a remission.  The aim of this study was to correlate the EORTC score with the recurrence and the progression in a Romanian cohort with NMIBC.

4. Material and method  We have realized a retrospective study on a total number of 305 patients admitted in the Urology Clinic of Târgu-Mureş with NMIBC, during 1 st of January 2006 and 31 st of December 2008, with an average follow-up period of 42 months.  The inclusion criteria were: bladder tumor at the first manifestation, treated by TUR-B (transurethral resection), T grade ≤T1;  The exclusion criteria was the lack of follow-up (15 patients).

5. Patients characteristics

6. Results Recurrence free survival 12 months: 78.6% 36 months: 72.5% Recurrence appeared in the case of 77 patients.

7. Results Progression free survival 12 months: 92.4% 36 months: 88.8% 60 months: 75% Progression appeared in the case of 34 patients

8. Progression and recurrence in patients treated with Bacillus Calmette–Guérin (BCG) p= 0.001 p= 0.8

9. EORTC risk scores comparison Recurrence EORTC study Our cohort EORTC study Our cohort 12 months 60 months 36 months 015%0%31%5.3% 1-424%13.8%46%20.5% 5-938%34.1%62%39.9% Progression EORTC study Our cohort EORTC study Our cohort 12 months 60 months 00.2%0%0.8%2.1% 1-61%3.7%6%11.9% 7-135%11.7%17%45.9% 14-2317%27.8%45%34% *36 months The EORTC study was performed on a total number of 2596 patients.

10. Kaplan-Meier survival curves based on EORTC risk scores High risk

11. Discussions  NMIBC is a common disease with highly variable behavior and outcome;  EORTC risk score tables help predict the recurrence and progression rate in the case of NMIBC;  From our results we noticed that patients with high-risk G3T1 should be followed carefully for recurrence and progression, and BCG treatment is mandatory for preventing progression towards muscle invase bladder cancer.  Also we found that progression rate was higher in our cohort than in the EORTC study, probably because of the high number of high-risk patients with G3 or T1 in our cohort.  From our knowledge, this is the first study realized in our country regarding the EORTC risk scores.

12. Discussions Other studies revealed similar findings:  A patient`s short and long-term probabilities of recurrence and progression can easily be calculated with a simple scoring system. [1]  In providing the long-term outcome of initially diagnosed TaG1 NMIBC after TUR-B, the present study provides an important external validation of the EORTC score for recurrence prediction. [2]  A significant concordance was noted between the EORTC’s predicted risk and the actual recurrence rate of stage Ta T1 bladder cancer at 1 year. [3]  Clinical utilization of the EORTC scoring system and risk tables is very effective in predicting the recurrence and progression of non-muscle-invasive bladder cancer. [4]

13. Conclusions  EORTC scores are an useful tool in predicting the recurrence and progression in NMIBC, even for Romanian patients and should be used in daily clinical practice;  Patients with high risk for progression and recurrence should benefit from a careful follow-up;  Despite the minimal differences, these tables provide the clinicians with a good starting point for discussing therapeutic options.

15. Bibliography  [1] Sylvester RJ, van der Meijden AP: ”Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials.” European Urology 49 (2006) 466-477;  [2] Bosset PO, Neuzillet Yann: ”Long-term follow-up of TaG1non–muscle-invasive bladder cancer.” Urologic Oncology: Seminars and Original Investigations (2015)20.e1–20.e7;  [3] Ather MH: ”Predicting Recurrence and Progression in Non Muscle Invasive Bladder Cancer Using European Organization of Research and Treatment of Cancer Risk Tables.” Urology Journal (2009), vol. 6:189-93;  [4] Seo KW, Kim BH : ”The Efficacy of the EORTC Scoring System and Risk Tables for the Prediction of Recurrence and Progression of Non-Muscle-Invasive Bladder Cancer after Intravesical BCG Instillation.” Korean J Urol 2010;51:165-170;  [5] Xylinas E, Kent M: ”Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder.” British Journal of Cancer (2013) 109, 1460–1466;  [6] Sylvester RJ: ”Natural History, Recurrence, and Progression in Superficial Bladder Cancer.” The Scientific World JOURNAL (2006) 6, 2617–2625;  [7] Walczak R, Bar K: ”The value of EORTC risk tables in evaluating recurrent NMIBC in everyday practice.” Central European Journal of Urology 2013; 66: 418-422;  [8] Vedder MM, Marquez M: ”Risk Prediction Scores for Recurrence and Progression of Non- Muscle Invasive Bladder Cancer: An International Validation in Primary Tumours.” PLOS ONE June 2014 | Volume 9 | Issue 6 | e96849;  [9] Pillai Rajiv: ”Application of EORTC Risk Tables for Non–Muscle Invasive (pTa/pT1) Bladder Cancer Recurrence and Progression in a Local Cohort.” The Scientific World JOURNAL (2011) 11, 751–759.