The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial.
To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG.
A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted.
A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes.
A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2).
Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy.
Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.
European urology oncology. 2024 Feb 13 [Epub ahead of print]
José Daniel Subiela, Wojciech Krajewski, Daniel A González-Padilla, Jan Laszkiewicz, Javier Taborda, Júlia Aumatell, Miguel Sanchez Encinas, Giuseppe Basile, Marco Moschini, Jorge Caño-Velasco, Enrique Lopez Perez, Pedro Del Olmo Durán, Andrea Gallioli, Andrzej Tukiendorf, David D'Andrea, Jeremy Yuen-Chun Teoh, Alejandra Serna Céspedes, Renate Pilcher, Luca Afferi, Francesco Del Giudice, Juan Gomez Rivas, Simone Albisinni, Francesco Soria, Guillaume Ploussard, Laura S Mertens, Paweł Rajwa, Ekaterina Laukhtina, Benjamin Pradere, Karl Tully, Félix Guerrero-Ramos, Óscar Rodríguez-Faba, Mario Alvarez-Maestro, Jose Luis Dominguez-Escrig, Tomasz Szydełko, Victoria Gomez Dos Santos, Miguel Ángel Jiménez Cidre, Francisco Javier Burgos Revilla, European Association of Urology-Young Academic Urologists EAU-YAU: Urothelial Carcinoma Working Group
Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain. Electronic address: ., Department of Minimally Invasive Robotic Urology, Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland., Department of Urology, Clínica Universidad de Navarra, Madrid, Spain., Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain., Servicio de Urología, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos Móstoles, Madrid, Spain., Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Hospital Universitario Gregorio Marañon, Madrid, Spain., Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Institute of Health Sciences, Opole University, Opole, Poland; University Clinical Hospital in Opole, Opole, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region., Medical University of Innsbruck, Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Innsbruck, Austria., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy., Department of Urology, Hospital Clínico San Carlos, Madrid, Spain., Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy., Division of Urology, Department of Surgical Sciences Molinette Hospital University of Torino School of Medicine, Torino, Italy., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Medical University of Silesia, Zabrze, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain; ROC Clinic, Madrid, Spain; Department of Urology, Hospital Universitario HM Sanchinarro, Madrid, Spain., Department of Urology, Hospital Universitario La Paz, Madrid, Spain., Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.