Pyuria as a Predictive Marker of Bacillus Calmette–Guérin Unresponsiveness in Non-Muscle Invasive Bladder Cancer

Abstract

This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette–Guérin (BCG) unresponsiveness in non-muscle invasive bladder cancer (NMIBC). We performed a logistic regression analysis on 453 patients with NMIBC who were treated with BCG immunotherapy after a transurethral resection of bladder tumours, to evaluate predictive factors of BCG unresponsiveness. We also analysed univariate and multivariable survival data to estimate the prognostic impact of pyuria. Of the total study population, 37.6% (170/453) of patients had BCG unresponsiveness. A multivariable logistic regression analysis revealed that a history of upper urinary tract cancer (odds ratio (OR): 1.86, 95% confidence interval (CI): 1.04–3.32, p-value = 0.035) and the presence of pyuria (OR: 1.51, 95% CI: 1.01–2.27, p = 0.047) and tumour multiplicity (OR: 1.80, 95% CI: 1.18–2.75, p-value < 0.001) were significant predictors of BCG unresponsiveness. A Cox proportional hazards analysis model showed that pyuria was a significant prognostic factor for progression-free survival (hazard ratio: 4.51, 95% CI: 1.22–16.66, p = 0.024). A history of upper urinary tract cancer and the presence of pyuria and tumour multiplicity are predictive markers of BCG unresponsiveness. For patients with NMIBC who have preoperative pyuria, treatment using BCG should be considered cautiously.

Pyuria as an independent predictor of intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial carcinoma

“…First, this was a retrospective study with possible selection bias, and further well-designed studies are required to confirm these results. Second, the definition of pyuria varies among studies, and even if we exclude bacteriuria, there are conditions other than tumors, such as inflammation or autoimmune diseases, that can cause pyuria [ 6 7 9 10 11 12 13 14 ]. Third, the reason neoadjuvant chemotherapy increased the risk for tumor recurrence is most likely because the patients with a history of neoadjuvant chemotherapy had a biased advanced cancer profile ( Supplementary Table 1 ).…”

“…Pathologic information included pathologic tumor, necrosis, and metastases stages; World Health Organization histologic grade; histologic variant; concomitant carcinoma in situ ; lymphovascular invasion; and condition of the surgical margin [ 15 16 ]. Pyuria was defined as five or more white blood cells per high-power field in centrifuged urine, in accordance with previous studies, and the urinalysis was done before the surgery [ 6 7 12 13 ]. Hydronephrosis was assessed with an abdomen-pelvis CT image.…”

“…Pyuria can be easily defined using urinalysis, and many studies have attempted to determine whether pyuria is a feasible tool for predicting the prognosis of UCs. Pyuria has been associated with a poor prognosis in non-MIBC and bacillus Calmette-Guérin unresponsiveness and recurrence [ 6 7 8 ]. Efforts to clarify the association between pyuria and UTUCs are ongoing, but given the rarity of UTUCs, previous studies are scarce and the results are controversial, especially regarding IVR after RNUx [ 9 10 ].…”

Intravesical Prostatic Protrusion and Prognosis of Non-Muscle Invasive Bladder Cancer: Analysis of Long-Term Data over 5 Years with Machine-Learning Algorithms

“…In addition, prolonged exposure to a carcinogen and implantation of floating cancer cells due to urine retention could activate the inflammatory response of patients. Recent studies showing that elevated C-reactive protein or pyuria, a result of an increased inflammatory response, are useful in predicting poor prognosis of bladder cancer and may also be related to these hypotheses [ 24 , 25 ].…”

Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data

“…Comparing cohorts with significantly different risks of intravesical recurrence is problematic. Past retrospective studies have reported that pyuria is a predictor of poor prognosis in patients who have undergone BCG treatment [ 12 ]. However, to the best of our knowledge, no studies have determined the risks of pyuria according to BCG treatment status.…”