OBJECTIVES: To analyze if the true number of BCG instillations applied in non-muscle invasive bladder tumors has any influence on their prognosis as well as other tumor and clinical characteristics: age, sex, different protocols, BCG dose, whether primary or recurrent, solitary or multiple, tumor size G3 or Cis.
PATIENTS AND METHODS: A total of 324 high grade NMIBC (15 TaG3, 184 T1G3, 125 Cis) out of 1491 cases included in the CUETO database were analyzed. Following 6 post transurethral resection (RTU) BCG instillations, the patients were scheduled to receive one instillation every two weeks (3-6 times), for a total of 9-12 instillations. One third of the dose (27mg) (112 cases) or total dose of 81mg (212 cases). Mean follow-up was 59.6 months. Statistical Analysis: Kaplan-Meier, Cox-regression (uni-multivariate).
RESULTS: A higher level of recurrence (p=0.032) and progression (P=.013) risk as well as worse Ca-specific survival (P=.005) were obtained if there were fewer than 12 instillations with the Kaplan-Meier and Cox-regression multivariate analysis. A 27mg (P=.008) dosage and being a female (P< .001) were independent factors for a higher recurrence risk, but not for progression or Ca-specific survival. The remaining characteristics studied were not statistically significant.
CONCLUSIONS: In accordance with the results obtained, we can conclude that the number of BCG instillations applied has some influence on the outcome of high grade NMIBC. The optimum number of instillations as well as their time of application must still be determined. A dose of 27mg and being a female are predictive factors of recurrence.
Written by:
Portillo JA, Madero R, Solsona E, Fernandez JM, Martínez-Piñeiro L, Palou J, Montesino M, Martínez-Piñeiro JA, Unda M. Are you the author?
Servicio de Urología, Hospital Universitario Marqués de Valdecilla (HUMV), Santander, España; Servicio de Bioestadística, Hospital La Paz, Madrid, España; Servicio de Urología, Instituto Valenciano de Oncología (IVO), Valencia, España; Servicio de Urología, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, España; Servicio de Urología, Hospital Infanta Sofía, Madrid, España; Servicio de Urologia, Fundacion Puigvert, Barcelona, España; Servicio de Urología, Hospital Virgen del Camino, Pamplona, España; Servicio de Urología, Hospital La Luz, Madrid, España; Servicio de Urología, Hospital Basurto, Bilbao, España.
Reference: Actas Urol Esp. 2014 Feb 13. pii: S0210-4806(13)00383-5.
doi: 10.1016/j.acuro.2013.10.010
PubMed Abstract
PMID: 24529538
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