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FGFR3 mutation analysis in voided urine samples to decrease cystoscopies and cost in nonmuscle invasive bladder cancer surveillance: a comparison of 3 strategies. | LitMetric

AI Article Synopsis

  • The study evaluated whether using FGFR3 mutation analysis of urine samples could be a cheaper and effective alternative to regular cystoscopy for monitoring patients treated for nonmuscle invasive urothelial carcinoma.
  • Data from 70 Dutch patients showed that modified surveillance (urine tests every 3 months and cystoscopy at specific intervals) had a higher probability of no recurrence after 2 years compared to standard and minimal surveillance strategies.
  • Overall, modified and minimal surveillance proved to be more cost-effective than standard cystoscopy, suggesting this approach is both safe and financially beneficial, although further studies are needed for confirmation.

Article Abstract

Purpose: We determined whether FGFR3 mutation analysis of voided urine samples would be cost-effective to partly replace cystoscopy in the surveillance of patients treated for nonmuscle invasive urothelial carcinoma.

Materials And Methods: In this decision analytical study we analyzed data on 70 Dutch patients with FGFR3 positive primary tumors and a median followup of 8.8 years. Surveillance strategies were compared in a Markov model. Modified surveillance consisted of FGFR3 mutation analysis of voided urine samples every 3 months, and cystoscopy at 3, 12 and 24 months. Standard surveillance was defined as cystoscopy every 3 months and minimal surveillance was defined as cystoscopy at 3, 12 and 24 months. Analysis was stratified for 3 risk profiles, including surveillance after 1) the primary tumor, 2) the first to third recurrence and 3) the fourth recurrence or more. Sensitivity analysis was performed to evaluate the impact of variations in cost, sensitivity and specificity.

Results: The probability of no recurrence after 2 years of surveillance after a primary tumor was higher for modified surveillance than for standard and minimal surveillance, eg after primary tumors (95.7% vs 95.0% and 93.9%, respectively). The total cost of surveillance after the primary tumor was lower for minimal and modified surveillance (€2,254 and €2,558, respectively) than for standard surveillance (€5,861). Results were robust to changing inputs over plausible ranges and consistent for each of the 3 risk profiles.

Conclusions: Surveillance in which cystoscopy is partly replaced by FGFR3 mutation analysis of urine seems a safe, effective and cost-effective surveillance strategy. Further validation in larger cohorts is required.

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Source
http://dx.doi.org/10.1016/j.juro.2012.11.005DOI Listing

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