Clinical outcomes after intravesical bacillus Calmette–Guérin for the highest‐risk non‐muscle‐invasive bladder cancer newly defined in the Japanese Urological Association Guidelines 2019

Abstract

Objective: To assess the clinical outcomes of highest-risk non-muscle-invasive bladder cancer patients treated with intravesical bacillus Calmette-Gu erin. Methods: The medical charts of patients with non-muscle-invasive bladder cancer treated with intravesical bacillus Calmette-Gu erin between 2000 and 2018 at a single institution were retrospectively reviewed. Patients were stratified into three groups (intermediate-, high-and highest-risk groups) according to the risk classification of the updated Japanese Urological Association guidelines 2019. Among the three groups, the intravesical recurrence-free survival and progression-free survival were estimated and compared, respectively. Furthermore, the different types of risk factors in the highestrisk group were analyzed. Results: Of the 165 patients, 49 (30%) patients had intravesical recurrence and 23 (14%) patients showed progression to muscle-invasive disease during a median follow-up period of 53 months. Significant differences were not noted in the recurrence-free survival and progression-free survival among the three groups. Multivariable survival analysis of 74 patients in the highest-risk group showed that carcinoma in situ in the prostatic urethra was a significant predictor associated with recurrence (hazard ratio 3.20, P = 0.026) and progression (hazard ratio 4.36, P = 0.013). Conclusions: Intravesical bacillus Calmette-Gu erin can control highest-risk non-muscleinvasive bladder cancer in most patients. Our findings might aid in decision-making regarding the treatment of this subset of patients who require intensive treatment, such as intravesical therapy with bacillus Calmette-Gu erin and radical cystectomy.

Intravesical Bacillus Calmette–Guérin Treatment for T1 High-Grade Non-Muscle Invasive Bladder Cancer with Divergent Differentiation or Variant Morphologies

“…We investigated the impact of concomitant DD and VMs in TUR specimens in T1/HG NMIBC patients who received intravesical BCG treatment. In our cohort, the frequency of some forms of DD or VMs was 6.4% (95/1490), which seemed to be much lower than that in previous studies [ 6 , 7 , 9 , 10 ]. This would be strongly attributed to biased patient selection.…”

“…Clinical practice guidelines suggest that intravesical BCG treatment is still an alternative therapeutic and adjuvant option after transurethral resection of a bladder tumor (TURBT) for high-/highest-risk NMIBCs [ 4 , 5 , 6 ]. Clinicians may judge that not all the patients with highest-risk NMIBC require RC because of the highly heterogenic nature of highest-risk NMIBC [ 7 ].…”

Prognostication in Japanese patients with bacillus Calmette‐Guérin‐unresponsive non‐muscle‐invasive bladder cancer undergoing early radical cystectomy

“…Therefore, it is often the case that RC is not performed for patients with highest‐risk NMIBC, and iBCG might be common in actual clinical practice. A previous study reported that highest‐risk NMIBC that was not BCG‐unresponsive benefitted from intravesical BCG therapy 10 . However, once the patients with the highest‐risk status developed BCG‐unresponsive NMIBC, the prognosis was extremely poor.…”

Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, andBCG‐treated disease

“…Although a few reports have been published, real‐world evidence from Japan is limited. Our previous single‐center retrospective study showed that 49 (30%) out of 165 patients treated with BCG developed BCG‐failure disease, and BCG‐unresponsive disease ( n = 18) was associated significantly with a high risk of progression compared with non‐BCG–unresponsive disease ( n = 31, p = 0.03) 80 . The Japan Urological Oncology Group created a large database across Japan consisting of more than 3000 patients with BCG‐treated NMIBC 81–84 .…”