TY - JOUR
T1 - Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes
AU - European Association of Urology—Young Academic Urologists (EAU-YAU): Urothelial carcinoma working group
AU - Krajewski, Wojciech
AU - Moschini, Marco
AU - Chorbińska, Joanna
AU - Nowak, Łukasz
AU - Poletajew, Sławomir
AU - Tukiendorf, Andrzej
AU - Afferi, Luca
AU - Teoh, Jeremy Yuen Chun
AU - Muilwijk, Tim
AU - Joniau, Steven
AU - Tafuri, Alessandro
AU - Antonelli, Alessandro
AU - Cianflone, Francesco
AU - Mari, Andrea
AU - Di Trapani, Ettore
AU - Hendricksen, Kees
AU - Alvarez-Maestro, Mario
AU - Rodríguez-Serrano, Andrea
AU - Simone, Giuseppe
AU - Zamboni, Stefania
AU - Simeone, Claudio
AU - Marconi, Maria Cristina
AU - Mastroianni, Riccardo
AU - Ploussard, Guillaume
AU - Laukhtina, Ekaterina
AU - Tully, Karl
AU - Kołodziej, Anna
AU - Krajewska, Joanna
AU - Piszczek, Radosław
AU - Xylinas, Evanguelos
AU - Zdrojowy, Romuald
N1 - Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Purpose: This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette–Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). Materials and methods: Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo’s approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results: The median TTBCG was 95 days (interquartile range (IQR): 71–127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. Conclusion: This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.
AB - Purpose: This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette–Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). Materials and methods: Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo’s approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results: The median TTBCG was 95 days (interquartile range (IQR): 71–127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. Conclusion: This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.
KW - BCG
KW - Bladder cancer
KW - Delay
KW - Survival
KW - Time
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U2 - 10.1007/s00345-020-03522-3
DO - 10.1007/s00345-020-03522-3
M3 - Article
AN - SCOPUS:85096587755
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
ER -