ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2018 October;70(5):501-8

DOI: 10.23736/S0393-2249.18.03042-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Long-term outcomes of high-grade T1 bladder cancer treated with intravesical bacillus Calmette-Guérin: experience of a single center

Rodolfo HURLE ¹, Nicolò BUFFI ¹, Giuliana LISTA ¹, Pasquale CARDONE ¹, Giovanni FORNI ¹, Davide MAFFEI ¹, Roberto PESCHECHERA ¹, Silvia ZANDEGIACOMO ¹, Luisa PASINI ¹, Alessio BENETTI ¹, Piergiuseppe COLOMBO ², Massimo LAZZERI ¹, Paolo CASALE ¹, Giorgio GUAZZONI ¹, Giovanni LUGHEZZANI ¹ ✉

¹ Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; ² Department of Pathology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

BACKGROUND: To assess the outcomes of patients with high-grade (HG) pT1 bladder cancer (BC) treated with intravesical BCG therapy.
METHODS: The study population consisted of 185 patients with HG pT1 BC treated between 1998 and 2010. We aimed to determine recurrence-free (RFS) and progression-free survival (PFS), as well as the predictors of RFS and PFS.
RESULTS: Overall, 143 (77.3%) patients were males. Median age was 72 years (IQR: 66-78). Tumor size was ≥3 cm in 100 (54.1%) individuals. Most patients had single tumors (125; 67.6%). Primary, progressive and recurrent patterns of presentation were observed in 146 (78.9%), 21 (11.4%), and 18 (9.7%) cases, respectively. After 2nd-look TURB, 127 (68.6%) patients had no residual disease, 44 (23.8%) had Ta/CIS, and 14 (7.6%) had T1 HG BC. Twenty-two (11.9%) patients experience early recurrence after BCG. Of these, 12 patients (54.5%) were diagnosed with Ta/CIS, while 10 (45.5%) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RFS and PFS rates were 69.6 and 79.2%. In multivariable Cox regression models, female gender (HR=2.41; P=0.001), progressive (HR=2.03; P=0.030) and recurrent (HR=3.87; P<0.001) pattern of presentation emerged as independent predictors of RFS, while age ≥70 years (HR=2.13; P=0.027), presence of multiple tumors (HR=2.06; P=0.019), and early recurrence (HR=3.88; P<0.001) emerged as independent predictors of PFS.
CONCLUSIONS: Intravesical BCG appears to be an effective treatment for HG pT1 BC. Caution should be used in patients aged ≥70 years, with multiple tumors or experiencing early recurrence.

KEY WORDS: Urinary bladder neoplasms - BCG vaccine - Treatment outcome