Introduction: Quality control indicators (QCIs) can objectively evaluate guideline adherence. We assessed 6 QCIs, based on guideline recommendations, in the treatment of NMIBC using a prospective transurethral resection of bladder tumor (TURBT) registry in 3 Belgian centers and assessed whether these QCIs correlated with clinical outcome of patients.
Methods: TURBT procedures were collected using electronic case report forms (eCRFs) in a prospective TURBT registry in 3 centers between 06-2013 and 03-2017. Outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cystectomy-free survival (CFS). Six QCIs were assessed for their indication: complete resection status (CRS), repeat resection (re-TUR), presence of detrusor muscle (DM) in the resection specimen, single post-operative instillation of Mitomycin C (MMC), adjuvant intravesical instillation of BCG, and initial therapy =6 weeks after diagnosis. Kaplan-Meier plots were used for visualization of outcome data and log-rank to compare clinical outcome for each QCI.
Results: A total of 1350 TURBTs were collected, 1165 TURBTs met inclusion criteria for a total of 907 patients. Median follow up was 21.8 mo (IQR: 12.1-34.3). RFS, OS, and CFS at 4-year were 63.5% (95%CI: 59.7-67.5), 78.9% (95%CI: 75.2-82.8), and 93.1% (95%CI: 91.4-94.9) respectively. Scores on QCI were: CRS: 97.1%, re-TUR: 33.6%, DM: 45.8%, MMC: 69.6%, BCG: 39.6%, and timing =6 weeks 87.7%. The following QCIs had a significant impact on outcome: CRS on OS, and CFS; re-TUR on OS (Figure 1A), and CFS; MMC on RFS (Figure 1B); BCG on RFS (Figure 1C), and OS (Figure 1D).
Conclusions: We demonstrate that we can assess QCIs (based onguideline recommendations) using a Belgian prospective multicenter TURBT registry. Furthermore, we demonstrate that the following QCIs were correlated with clinical outcome of patients: CRS, re-TUR, MMC, and BCG. Therefore, QCIs could be used to check guideline adherence, and allow for comparison between centers, with the ultimate goal of increasing guideline adherence. Source of