Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital

Area of Science:

• Urology
• Oncology
• Clinical Research

Background:

• Non-muscle invasive bladder cancer (NMIBC) management increasingly relies on risk stratification.
• European Organization for Research and Treatment of Cancer (EORTC) risk tables are standard tools for predicting NMIBC recurrence and progression.
• Assessing the utility of these risk tables in diverse populations is crucial for refining treatment strategies.

Purpose of the Study:

• To evaluate the recurrence and progression rates of NMIBC in Nepalese patients.
• To validate the predictive accuracy of the EORTC risk tables for this patient cohort.
• To assess the effectiveness of intravesical therapies, particularly Bacillus Calmette Guerin (BCG), in reducing NMIBC recurrence.

Main Methods:

• A prospective observational study was conducted at a single center involving 46 NMIBC patients.
• Patients were stratified into low, intermediate, and high-risk groups using EORTC risk tables.
• Follow-up data over two years were collected, and adjuvant therapies were administered according to European Association of Urology guidelines.

Main Results:

• The overall two-year recurrence and progression rates were 17% and 2%, respectively.
• No recurrence or progression was observed in the low-risk group (n=7).
• Recurrence rates in intermediate (n=15) and high-risk (n=24) groups were 20% and 21% at two years, respectively, with intravesical BCG showing a 58-60% risk reduction in high-risk patients.

Conclusions:

• Risk-based management using EORTC tables is a valuable approach for NMIBC.
• The EORTC risk tables demonstrated lower predictive accuracy in the Nepalese population compared to established data.
• Intravesical BCG therapy proved effective in reducing recurrence risk, especially in high-risk NMIBC patients.