Mp71-02 What Will It Take to Replace Surveillance Cystoscopy With Urine Biomarker X? A Monte-Carlo Simulation

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-02 WHAT WILL IT TAKE TO REPLACE SURVEILLANCE CYSTOSCOPY WITH URINE BIOMARKER X? A MONTE-CARLO SIMULATION Zhuo T. Su, James Flynn, Aurora Grutman, Royce Lee, Katherine Mahon, Michael Rezaee, Nirmish Singla, Sunil Patel, and Max Kates Zhuo T. SuZhuo T. Su , James FlynnJames Flynn , Aurora GrutmanAurora Grutman , Royce LeeRoyce Lee , Katherine MahonKatherine Mahon , Michael RezaeeMichael Rezaee , Nirmish SinglaNirmish Singla , Sunil PatelSunil Patel , and Max KatesMax Kates View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is the most expensive malignancy to treat over the lifetime of a patient. Regimented cystoscopic surveillance of NMIBC is associated with high costs and reduced quality of life for patients. We aimed to identify the required diagnostic accuracy of a potential urine biomarker to replace surveillance cystoscopy for high-grade (HG) T1 NMIBC. METHODS: We developed a Monte-Carlo simulation to model the 10-year cumulative incidence (CI) of muscle invasive bladder cancer (MIBC), cancer-specific survival (CSS), and overall survival (OS) for a cohort of 10,000 patients diagnosed with HGT1 NMIBC at age 70 years. In the reference case, patients underwent surveillance with cystoscopy and cytology per schedule in the 2020 American Urological Association (AUA) guideline. In experimental cases, patients underwent cystoscopy with a hypothetical urine biomarker test 3 months after diagnosis. If negative, patients were then tested with the urine biomarker only, instead of cystoscopy and cytology, at each surveillance point in the AUA schedule. A positive test would trigger cystoscopy in the operating room and transurethral resection or biopsy as needed. We varied the biomarker's sensitivity for detecting low-grade (LG) and HG cancer from 60% to 95%. RESULTS: In the reference case, 10-year MIBC CI was 11.6%, CSS was 94.7%, and OS was 70.5%. In experimental cases, as the sensitivity of the urine biomarker increased from 60% to 95%, MIBC CI decreased from 12.0% to 11.6%, CSS improved from 94.4% to 94.7%, and OS varied minimally from 70.4% to 70.5%. As the sensitivity reached 93%, the absolute difference in both 10-year MIBC CI and CSS versus the reference case came down to ≤0.1% (Figure 1). These results were independent of the specificity of the biomarker. CONCLUSIONS: Against a threshold of an absolute difference of ≤0.1% in 10-year MIBC CI and CSS compared to current guideline-recommended practice, the sensitivity of a urine biomarker for detecting LG and HG cancer needs to be ≥93% to replace cystoscopy in surveillance of HGT1 NMIBC. Such a sensitive biomarker, combined with sufficient specificity to avoid frequent false positives, could reduce the economic burden of bladder cancer care and adverse impact on the quality of life for patients due to routine cystoscopic surveillance. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1160 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zhuo T. Su More articles by this author James Flynn More articles by this author Aurora Grutman More articles by this author Royce Lee More articles by this author Katherine Mahon More articles by this author Michael Rezaee More articles by this author Nirmish Singla More articles by this author Sunil Patel More articles by this author Max Kates More articles by this author Expand All Advertisement PDF downloadLoading ...