The Vlaams Ziekenhuisnetwerk-KU Leuven (VZNKUL)-NMIBC Quality Indicators Program, initiated in 2013, is showing promise in evaluating and improving the treatment of non-muscle-invasive bladder cancer (NMIBC). A recent analysis of 2237 patients within this Flemish prospective cohort, followed across seven academic and non-academic hospitals, reveals valuable insights into treatment patterns and outcomes.
Study Design and Patient Characteristics
The VZNKUL-NMIBC registry prospectively collects comprehensive data, including patient characteristics, tumor details, treatment approaches, and oncological outcomes. The study, registered on ClinicalTrials.gov (NCT04167332), analyzed 4744 transurethral resections of bladder tumors (TURBTs) performed between June 2013 and December 2020. The majority of patients (80%) were men, with a median age of 73 years. The median time from diagnosis to TURBT was 19 days.
Key Findings
Key findings from the analysis include:
- A single tumor was detected in 37% of TURBTs, with tumors larger than 3 cm found in 20.8% of cases.
- A reTURBT was scheduled according to guidelines in 46% of TURBTs.
- Postoperative single intravesical instillation of chemotherapy (SIVIC) was administered to 56.9% of 1533 indicated patients, with a median time to administration of 4.7 hours.
- 60.4% of the cohort had NMIBC, and 9.3% had muscle-invasive BC.
- Of 972 high-risk patients, 60.7% received adequate BCG induction, while 39.4% received adequate maintenance. After BCG induction ± maintenance, 39.7% were tumor-free, with 17.7% recurrence and 4% progression to muscle-invasive BC. BCG treatment was terminated early for 17% of patients due to intolerance.
- Early cystectomy was performed for 2.4% of the BCG-naïve patients, and 27.7% of patients with BCG failure underwent a BCG rechallenge.
- For intermediate-risk patients, 2.1% received adequate BCG, and 23% received intravesical chemotherapy.
Survival Rates and Clinical Outcomes
With a median follow-up of 57 months, the five-year recurrence-free, progression-free, cancer-free, overall, and cancer-specific survival rates were 53%, 91.6%, 89%, 70.6%, and 95.6%, respectively, for the NMIBC patients. Among 400 non-metastatic MIBC patients, 217 (54.3%) underwent radical cystectomy (RC), of whom 46% received neoadjuvant chemotherapy, while 18 (4.5%) refused RC, and 74 (18.5%) were considered unfit for the surgery.
Implications for Clinical Practice
The VZNKUL-NMIBC Quality Indicators Program Registry will continue collecting data to evaluate QCIs and monitor treatment quality, enabling hospitals to benchmark their performance and improve patient care. Additionally, the registry's real-world data can support research and international collaboration. These findings underscore the importance of adherence to EAU guidelines and highlight areas for improvement in the management of NMIBC.
