AUA 2020: Multi-Institutional Outcomes of Patients with High-Risk Non-Muscle Invasive Bladder Cancer Who Undergo Radical Cystectomy After BCG and Subsequent Salvage Intravesical Therapy

The median follow-up among survivors was 1.1 (IQR 0-4.3) years, during which time 149 patients died, including 79 from bladder cancer. Age, race, body mass index (BMI), and Charlson Comorbidity Index were similar between groups. Patients who received salvage intravesical therapy were more likely to initially present with carcinoma in situ (CIS) (27% vs 17%) and less likely to present with T1 disease (33% versus 50%, both p<0.05). Receipt of salvage intravesical therapy was not associated with increased risk of adverse pathology (≥pT2 or pN+) at radical cystectomy (33% versus 41%, p=0.27).

Furthermore, on Kaplan-Meier analysis, receipt of salvage intravesical therapy was not associated with cancer-specific or overall survival. On multivariable Cox proportional hazards regression analysis, clinical-stage prior to radical cystectomy (CIS vs Ta hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.01-3.32; T1 vs Ta/CIS HR 3.12, 95% CI 1.37-7.13; T2 vs Ta/CIS HR 6.92, 95% CI 3.22-14.9), but not receipt of salvage intravesical therapy (HR 1.07, 95% CI 0.55-2.04), was associated with inferior cancer-specific survival. On matched analysis, salvage intravesical therapy remained without association with survival outcomes. 

Dr. Packiam concluded his presentation with the following take-home messages:

• These results suggest that radical cystectomy following salvage intravesical therapy after BCG is not associated with inferior oncologic outcomes
• While careful management should continue to be used in this setting, these data can improve counseling for patients considering salvage intravesical therapy trials