A Composite Risk Score Based on VI-RADS, Tumor Contact Length, and CYFRA 21-1 for Prognostic Stratification in...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• The Vesical Imaging-Reporting and Data System (VI-RADS) shows high accuracy for muscle-invasive bladder cancer (MIBC) but has limited prognostic value.
• Serum cytokeratin 19 fragment (CYFRA 21-1) and tumor contact length (TCL) are proposed as complementary prognostic factors for MIBC.

Purpose of the Study:

• To develop and validate a composite risk score integrating VI-RADS, CYFRA 21-1, and TCL for prognostic stratification of bladder cancer (BC) patients.
• To assess the prognostic value of individual factors and the composite score for overall survival (OS).

Main Methods:

• Retrospective analysis of 101 BC patients who underwent transurethral resection of bladder tumor (TURBT), MRI, and CYFRA 21-1 measurement.
• Determination of cut-off values for VI-RADS, TCL, and CYFRA 21-1 using ROC analysis; a composite score (0-3) was created.
• Overall survival (OS) was analyzed using Kaplan-Meier and Cox regression models.

Main Results:

• Optimal cut-offs were VI-RADS ≥ 3, TCL ≥ 40 mm, and CYFRA 21-1 ≥ 2.1 ng/mL.
• The composite score stratified patients into low (0-1), intermediate (2), and high-risk (3) groups with significantly different 3-year OS rates (95.1%, 75.0%, 25.0%; p < 0.001).
• Univariate analysis showed VI-RADS, TCL, and CYFRA 21-1 were significant predictors of poor OS. Multivariate analysis identified CYFRA 21-1 as the only independent predictor (HR, 11.80; p < 0.001).

Conclusions:

• A composite risk score integrating VI-RADS, TCL, and CYFRA 21-1 provides effective prognostic stratification for BC patients.
• This minimally invasive score, using peri-TURBT assessments, can aid in clinical decision-making.
• Prospective multicenter validation is recommended to confirm the findings.