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Vol. 46. Issue 4.
Pages 230-237 (May 2022)
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Vol. 46. Issue 4.
Pages 230-237 (May 2022)
Original article
Optimizing treatment for non muscle-invasive bladder cancer with an app
Optimización del tratamiento del cáncer de vejiga no músculo invasivo mediante una app
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P. Beardoa,
Corresponding author
Beardo.pastora@gmail.com

Corresponding author.
, R. Pintob, H. Ayerrab, J. Agüeraa, S. Armijosc, J.L. Álvarez-Ossorioa
a UGC Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain
b Servicio de Urología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
c e-processmed, Vitoria-Gasteiz, Spain
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Tables (2)
Table 1. Clinicopathological characteristics in both treatment groups (urologist-APPv agreement group, urologist-APPv disagreement group) and in the overall series.
Table 2. Types of post-TUR treatment proposed by the urologist and treatment proposed by the APPv.
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Abstract
Objectives

To evaluate overall and recurrence-progression rate-adjusted concordance of treatment prescription in non-muscle-invasive bladder cancer (NMIBC) of an app based on the best available scientific evidence and the urologist's opinion.

Methods

Development of an app (APPv) specifically designed for the treatment and follow-up of NMIBC and validation of the proposed APPv treatment endpoint by means of a prospective double-blind observational concordance study of related samples in 100 patients with initial or successive histological diagnosis of NMIBC.

Results

The treatment prescribed by the urologist agrees with that proposed by the APPv in 64% of cases (kappa index 0.55, P < 0.0001). Regarding low risk, the agreement is 77% (kappa 0.55, P = 0.002), 63% (kappa 0.52, P < 0.0001) for intermediate risk, 17% (kappa 0.143, P = 0.014) in high risk and 66% (kappa 0.71, P = 0.01) for very high risk. Of patients receiving adjuvant intravesical treatment according to APPv, 89.1% remain free of recurrence vs. 61.1% of those with disagreement (P = 0.0004), with a RR 0.46 (95%CI: 0.25-0.86) vs. RR 2.4 (95%CI: 1.5-3.8, P = 0.001). In the APPv-urologist agreement group, 100% of patients are free of progression and 88.9% in the disagreement group (P = 0.004) with a RR 1 vs. RR 1.125 (95%CI: 1-1.26, P = 0.004).

Conclusions

APPv can improve adherence to treatment recommendations according to clinical practice guidelines and health outcomes at NMIBC.

Keywords:
Non-muscle-invasive bladder cancer
Apps medica
reTUR
Intravesical BCG
Adherence to clinical guideline
Resumen
Objetivos

Evaluar la concordancia global y ajustada por tasa de recidiva-progresión de la prescripción del tratamiento en el cáncer de vejiga no músculo-invasivo (NMIBC) de una app basada en la mejor evidencia científica disponible y la opinión del urólogo.

Métodos

Desarrollo de una app específica para el tratamiento y seguimiento del NMIBC (APPv) y validación de la variable de salida propuesta de tratamiento mediante un estudio de concordancia observacional prospectivo de muestras relacionadas a doble ciego en 100 pacientes con primer o sucesivo diagnóstico histológico de NMIBC.

Resultados

El tratamiento prescrito por el urólogo coincide con el propuesto por la APPv en el 64% de los casos (índice kappa 0,55; p < 0,0001). La coincidencia para el bajo riesgo es del 77% (kappa 0,55; p = 0,002), 63% (kappa 0,52; p < 0,0001) para el riesgo intermedio, 17% (kappa 0,143; p = 0,014) en alto riesgo y 66% (kappa 0,71; p = 0,01) para muy alto riesgo. El 89,1% de los pacientes que reciben el tratamiento complementario intravesical acorde con la APPv continúan libres de recidiva, frente al 61,1% en que no hay acuerdo (p = 0,0004), con un RR de 0,46 (IC 95%: 0,25-0,86) vs. RR de 2,4 (IC 95%: 1,5-3,8; p = 0,001). El 100% de los pacientes están libres de progresión en el grupo de acuerdo y el 88,9% en el grupo sin acuerdo (p = 0,004) con un RR de 1 vs. RR de 1,125 (IC 95%: 1-1,26; p = 0,004).

Conclusiones

La APPv puede mejorar la adherencia a las recomendaciones de tratamiento según las guías de práctica clínica y los resultados en salud en el NMIBC.

Palabras clave:
Cáncer de vejiga no músculo-invasivo
Apps médicas
Re-RTU
BCG intravesical
Adherencia a las recomendaciones de las guías clínicas

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