Factors Associated with Recurrence in Primary Carcinoma in situ of the Bladder Treated with Bacillus Calmette-Guérin - Expert Commentary
A retrospective study published by Kim et al. evaluated the contribution of various factors on the on clinical outcomes of P-CIS patients who received BCG treatment. The authors reviewed the medical records of 5,945 patients between 1999 and 2014 including 64 patients with P-CIS who completed 6+ cycles of BCG treatment.
The authors found that older P-CIS patients had a higher recurrence after BCG therapy. Patients who had no gross hematuria at the time of diagnosis also had a higher recurrence rate than those with gross hematuria. On the other hand, the authors found that patients who were diagnosed with hypertension and taking anti-hypertensive drugs had a lower recurrence rate than those not taking anti-hypertensive drugs. When compared different anti-hypertensive drugs, they found that patients who are taking ACEIs/ARBs have fewer recurrences than other types of antihypertensive medications. Smoking status or urine cytology did not significantly affect the recurrence-free survival after BCG treatment. The authors speculate that this may be the effect of ARB on the angiotensin II type I receptor (AT1R) which affects. tumor growth and angiogenesis.
The study is limited by the small number of P-CIS cases and these results should be considered hypothesis-generating. Understanding the biological features that determine the clinical course of P-CIS deserves more study.
Written by: Bishoy M. Faltas, MD, Weill Cornell Medicine, New York, NY
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Reference:
Kim SJ, Nam W, You D, Jeong IG, Song C, Hong B, Kim CS, Ahn H, Hong JH. Urol Int. 2018 Sep 4:1-8. doi: 10.1159/000492121.Urol Int. 2018 Sep 4:1-8. doi: 10.1159/000492121.