Opinion
Video
Appropriate Risk Stratification Intermediate and high-risk Risk Classification
Experts discuss grading, staging, and risk stratification of Non-Muscle Invasive Bladder Cancer (NMIBC). Panelists highlight differentiation between the risks of recurrence and progression, emphasizing the importance of categorizing patients into low, intermediate, and high-risk groups based on various factors, including tumor size, grade, and history of recurrence. The importance of continuous prospective observation of patients with NMIBC is emphasized.
This is a synopsis of the Viewpoints video series featuring moderator, Sam S. Chang, MD, MBA, from Vanderbilt University School of Medicine, and panelists Gary Steinberg, MD, FACS, from Rush University Medical Center, Mark Tyson, MD, of Mayo Clinic Phoenix, Roger Li, MD, from Moffitt Cancer Center, and Sandip M. Prasad, MD, MPhil, of Morristown Medical Center.
Episode 2 focuses on the grading, staging, and risk stratification of Non-Muscle Invasive Bladder Cancer (NMIBC). The experts underscore the importance of accurately categorizing patients into low, intermediate, and high-risk groups based on factors like tumor size, grade, and history of recurrence. Gary Steinberg, MD, FACS, speaks about the necessity of differentiating the risk of recurrence from the risk of progression, especially in high-grade disease like carcinoma in situ (CIS) and/or T1 disease. He emphasizes the need for continuous, prospective patient observation to better understand the true risk of recurrence and progression. Roger Li, MD, delves into the intermediate risk category, which encapsulates diseases that span between low risk and high risk, including small, low-grade, and high-grade patients, whether it be CIS, TA, or T1 high-grade disease. He notes the significance of the TA high-grade patients that are less than three centimeters on cystoscopic evaluation, which are categorized as intermediate risk according to the American Urological Association (AUA) guidelines. The panel also discusses the importance of tiered systems of intravesical therapy to prevent recurrences based on the number of risk factors present at diagnosis. The panelists highlight the challenges in bucketing patients into risk groups, particularly in distinguishing between low-end and high-end patients within the same risk category. The discussion also touches on the National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) guidelines, which have further stratified the high-risk category to better care for these patients.
In conclusion, the panel underscores the importance of differentiating between recurrence and progression risks in NMIBC and the necessity for ongoing research and data collection to improve risk stratification and patient care.
*Video synopsis is AI-generated and reviewed by Urology Times® editorial staff.
