Andrew Stephenson

Cleveland Clinic

PLCO (Learn more about this study)

2009-0075

May 26, 2009

Nomogram predicting the risk bladder cancer and high-grade bladder cancer

Bladder cancer is the 6th most common cancer in American males and 9th most common cancer amongst American women. In 2008, an estimated 14,000 people will die from this disease in the United States. About two-thirds of bladder cancer are non-invasive and low-grade and are unlikely to cause serious morbidity or cause the patients demise. However, the need for lifelong endoscopic bladder cancer surveillance in these patients renders bladder cancer one of the most expensive cancers to treat. About one-third of bladder cancers are invasive and/or high-grade. Despite multimodal treatment with surgical resection and cisplatin-based chemotherapy, approximately 50% of patients with high-grade and/or invasive disease will die from bladder cancer. Efforts to reduce the mortality from this disease must focus on the development of more effective systemic therapy and primary and secondary bladder cancer prevention strategies. The latter two strategies may also substantially reduce the cost of treating bladder cancer by also preventing the development of non-invasive, low-grade tumors. Efforts to develop effective screening and/or prevention strategies have been limited by the relatively low incidence of this disease in the general population; particularly patients with potentially lethal bladder (as defined by the presence of invasive and/or high-grade cancer). Many environmental exposures are associated with an increased risk of developing bladder cancer (e.g. smoking history, exposure to aromatic amines, radiation therapy, chemotherapy, chronic infection and/or inflammation), tools to estimate the risk of bladder cancer for the individual patient combining these and other risk factors are currently unavailable. The absence of a premalignant bladder cancer lesion limits the ability to effectively develop secondary prevention strategies. The ability to define a high-risk patient population based on demographic information and presence of risk factors will be useful for targeting a population for whom bladder cancer screening would be most helpful and cost-effective and potentially to target for primary or secondary prevention strategies. The investigators have a long history of developing multivariable prediction tools called nomograms that accurately predict the risk of cancer or response to therapy. These nomograms have been shown to be substantially more accurate than risk grouping strategies or prognostic indices. These nomograms are widely used for patient counseling and treatment decision-making. We endeavor to use clinical data obtained from the PLCO trial to predict the risk of developing bladder cancer (and potentially lethal bladder cancer) by developing a nomogram. This nomogram is anticipated to have utility to develop effective screening strategies and/or prevention strategies to reduce the morbidity and mortality of bladder cancer.