Identification of Risk Factors of Tumor Recurrence and Model Establishing for Patients with Intermediate and Higher Risk NMIBC Followed by Intravesical BCG Instillation After TmLRBT or TURBT

Abstract

Abstract Purpose The disease recurrence and progression bring great burden to patients with intermediate and higher risk non-muscle invasive bladder cancer (NMIBC). Intravesical bacille Calmette-Guérin (BCG) instillation is recommended as a preventive treatment of disease recurrence and progression for NMIBC patients after conventional transurethral resection of bladder tumors (TURBT) or thulium laser resection of bladder tumors (TmLRBT). In this study, we constructed a novel nomogram to predict postoperative tumor recurrence and progression for BCG-treated patients with intermediate and higher risk NMIBC after TURBT or TmLRBT. Methods Patients with intermediate, high and very high risk NMIBC that undergone TURBT or TmLRBT followed by BCG instillation were retrospectively collected from August, 2018 to December, 2019. Independent prognostic factors were determined by univariate logistic regression, multivariable logistic regression, the least absolute shrinkage and selection operator (LASSO) regression and multivariable cox regression. A nomogram was established to calculate the recurrence and progression probability of targeted patients. The predictive efficacy of this nomogram model was also evaluated. Results 76 patients were included, among which 22 experienced tumor recurrence. The multivariable cox regression showed that previous bladder tumor history (HR = 4.07, 95% CI: 1.56 ~ 10.60, P = 0.004) and number of BCG immunotherapy (HR = 0.87, 95%CI: 0.82 ~ 0.93, P < 0.001) were two independent prognostic factors of bladder tumor recurrence. A nomogram model was established and proofed to have good predictive capacity. Conclusion Patients without previous bladder tumor history and having more intravesical BCG instillations are likely to have better RFS. The nomogram and the risk index which were constructed to predict the RFS and PFS of patients may help urologists choose appropriate disease management for patients.