AFU Registry of the Therapeutic Management and Follow-up of Non-Muscle-Invasive Bladder Cancer

Study Overview
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Brief Summary
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The AFU has set itself the task of setting up a register of medical practices in order to define possible improvements in the therapeutic management and follow-up of NMIBC. In order to obtain representative data, all urologists who are members of the AFU may be invited to include their patients in accordance with the rules of clinical research.

Detailed Description
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BACKGROUND Non-muscle infiltrating bladder tumors are a cancerous pathology with an estimated incidence of 13,000 new cases/year in France. ¾ of new cases are diagnosed at a stage where the cancer is of limited extension to the urothelial mucosa and/or its underlying chorion (non-muscle-infiltrating bladder tumors, NIMBT). The management and follow-up of NMITVs are performed according to the best practice recommendations issued by the Cancer Committee of the French Urology Association. The risk of recurrence at 1 and 5 years for NMITT has been estimated in clinical trials to be between 15%-61% and 31%-78%, respectively, depending on grade, stage, number, size, frequency of previous recurrence and presence of carcinoma in situ. In this context, patients should have regular endoscopic examinations to ensure the absence of tumor lesions inside their bladder. Urine cytology pathology is recommended for the detection of recurrence of NMITV. However, the negative predictive value of this examination does not allow it to be substituted for bladder endoscopy, as the risk of not recognizing a bladder tumor, especially of low grade, is too high. To date, no urinary biomarker has been shown to be clinically useful and their use is not recommended for the non-invasive detection of endovesical tumor recurrence. Urine sampling is recommended prior to bladder endoscopy for follow-up of NMITV to ensure urine sterility (UDEC) and to perform urine cytology in patients with high-grade NMITV and/or carcinoma in situ. The observational study of the clinical validity of the negative and positive predictive values of the biomarkers in a population of patients followed for a bladder tumor previously characterized is able to demonstrate the possibility of postponing the realization of the fibroscopy according to the tumoral characteristics and the treatments received by the patients. OBJECTIVE The main objective of the research will be to evaluate the diagnostic performance of biomarkers available in France, performed on a urine sample and providing a binary result (positive: probable presence of a tumor recurrence; negative: probable absence of a tumor recurrence) to the result of the bladder endoscopy performed as part of the routine care for the follow-up of NMVT: determination of the negative and positive predictive values of biomarkers. The secondary objectives will be to describe the anatomopathological characteristics, the pathological history and the treatments received in the population. MATERIAL AND METHOD Before each examination, the participating patients will produce a urine sample of approximately 20 to 40 ml in total dedicated to the determination of the marker proposed by your urologist, made by medical analysis laboratory. At each follow-up endoscopic examination scheduled in the patient's personalized care plan, the investigating urologist will record its date and endoscopic findings (white light bladder fibroscopy). The name and result of the urine test will also be recorded by the investigating urologist. The performance of the test will be evaluated from these data by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and by means of an analysis of variance (ANOVA) to explore possible differences within the test by tumor grade and stage, and according to previous endovesical treatments received The inclusion target is 2000 patients in France over a 3-year period.

Official Title
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AFU Registry of the Therapeutic Management and Follow-up of Non-Muscle-Invasive Bladder Cancer

Conditions
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Non-Muscle-Invasive Bladder Cancer

Intervention / Treatment
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* Diagnostic Test: Urinary Biomarkers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: NMIBC (possibility of non-dominant histologic variants) or urothelial tumor of low malignant potential confirmed by endoscopic resection of one or more bladder tumors and/or bladder biopsies. Exclusion Criteria: Non-urothelial bladder tumor

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Urinary Biomarkers|Prior to each examination, participating patients will produce a urine sample of approximately 20 to 40 ml in total dedicated to the determination of the marker proposed by your urologist, done by medical analysis laboratory. At each follow-up endoscopic examination scheduled in the patient's personalized care plan, the investigating urologist will record its date and endoscopic findings (white light bladder fibroscopy). The name and result of the urine test will also be recorded by the investigating urologist. The performance of the test will be evaluated from these data by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and by means of an analysis of variance (ANOVA) to explore possible differences within the test by tumor grade and stage, and according to previous endovesical treatments received|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recurrence-Free Survival | New bladder cancer (Whether NMIBC or MIBC). | 5 years | 
| Performance of biomarkers | To evaluate the diagnostic performance of biomarkers available in France, analyzed on a urine sample and providing a binary result (positive: probable presence of a tumor recurrence; negative: probable absence of a tumor recurrence) correlated to the result of the bladder endoscopy performed as part of the routine care for the follow-up of NMVT: determination of the negative and positive predictive values of biomarkers. | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-Free Survival | New bladder cancer (MIBC). | 5 years |