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02-06-2013 | Oncology | Article

Pyuria predicts poor outcome in NMIBC

Abstract

Free abstract

medwireNews: Japanese research shows that pyuria at diagnosis is independently associated with disease recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC).

The study, published in Clinical Genitourinary Cancer, found that the 3-year rate of recurrence-free survival was just 10.9% in patients with pyuria compared with 45.0% in patients without, and 5-year progression-free survival was 72.3% and 95.7%, respectively.

Takeshi Azuma (Tokyo Metropolitan Tama Medical Center) and colleagues say that if their findings are validated, "the presence of pyuria may add to the known EORTC [European Organization for Research and Treatment of Cancer] risk groups and could predict the prognosis of patients with NMIBC more accurately."

The study included 805 patients diagnosed with Ta or T1 NMIBC between 1994 and 2007, who were treated by transurethral resection of the bladder tumor, and followed up at 3-month intervals. Overall, 191 (24%) had baseline pyuria, defined as 10 or more white blood cells per high power field of urine.

In multivariate analysis, pyuria was associated with a 2.3-fold increased risk for recurrence (86 vs 57%).

In all, 75 (9%) patients progressed to MIBC, and patients presenting with pyuria were 5.5 times more likely to do so than patients without (24 vs 5%). Additionally, the authors note that the majority (86%) of patients presenting with primary MIBC, who were excluded from the main analysis, had pyuria.

Furthermore, Azuma and colleagues show that, after dividing patients into risk groups for recurrence and progression, according to EORTC criteria, presence of pyuria was still significantly associated with poorer outcome.

For example, in the intermediate-low-risk group for recurrence, 3-year recurrence-free survival was 12.0% in patients with pyuria compared with 42.1% in patients without pyuria. And, in the intermediate-high-risk group for progression, 5-year progression-free survival was 43.9% versus 85.1%.

Noting that the intermediate-risk group has questionable utility, the authors say this finding could add additional classification to the EORTC, which "could be helpful in predicting the recurrence and progression rate, deciding the treatment, and establishing a follow-up plan."

"Further study is warranted to validate these results and control for subsequent treatments," they conclude.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter