Who needs numbers more: patients or doctors?

One of the most burning problems of modern urology still remains the treatment of bladder cancer, which has the highest recurrence rate of any malignancy. Depending on a patient's individual characteristics, the probability of recurrence of non–muscle invasive bladder cancer (NMIBC) at one–year ranges from about 20% to 72% and the probability of progression at five years ranges from about 5% to 45%. In 2006, Sylvester et al. published a paper based on data from 2,596 patients with NMIBC included in seven trials conducted by European Organization for Research and Treatment of Cancer (EORTC) [1]. Their aim was to provide a simple scoring system based on universally assessed clinical pathological factors, which might allow urologists to easily calculate the risk of recurrence and progression after trans-urethral resection of the bladder tumor (TURBT). Many authors verified the value of this calculator whether it may be replicated and adopted into every day practice. The results were divergent, mostly due to smaller number of cases than those impressively collected by Sylvester. Altieri et al. and Fernandez– Gomez et al., after analysis of 259 and 1,062 cases of NMIBC respectively, found them useful for strat-ification of recurrence and progression in their co-horts, and suggested the introduction EORTC risk tables into clinical practice [2, 3]. However, a mul-ticenter Spanish team concluded that the discrim-inative ability of the EORTC tables decreased in patients with BCG progression and overestimated the risk of recurrence in this subgroup of patients [3]. In other words, it makes these tables less useful in high–risk patients. The practical proposal from these and some other studies may be expressed by generally stating that patients from groups stratified as high–risk need more frequent and careful follow–up [4]. The authors of the paper published in this issue of CEJU performed another external validation of EORTC tables in the group of 91 patients with NMIBC [5]. However, this paper concerns clinically important problems, but while both the incidence of bladder cancer is high and EORTC tables still need to be validated in contemporary series of patients, in my opinion, the authors leave us with some unaddressed and unexplained issues. First of all, I feel the lack of clear definition of progression used by the authors. If it was proven by pathological examination, what was the protocol and classification used? Time to progression as defined by EORTC is the time from randomization to the date of first …