Optimización del tratamiento del cáncer de vejiga no músculo invasivo mediante una app / Optimizing treatment for non muscle-invasive bladder cancer with an app

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. (AU)

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. (AU)

Optimizing treatment for non muscle-invasive bladder cancer with an app.

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.