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

Rodolfo Hurle, Nicolò Buffi, Giuliana Lista, Pasquale Cardone, Giovanni Forni, Davide Maffei, Roberto Peschechera, Silvia Zandegiacomo, Luisa Pasini, Alessio Benetti, Piergiuseppe Colombo, Massimo Lazzeri, Paolo Casale, Giorgio Guazzoni, Giovanni Lughezzani

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2 Citations (Scopus)

Abstract

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 (RF S) and progression-free survival (PFS), as well as the predictors of RF S 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/CI S, 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/CI S, while 10 (45.5%) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RF S 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.

Original languageEnglish
Pages (from-to)501-508
Number of pages8
JournalMinerva Urologica e Nefrologica
Volume70
Issue number5
DOIs
Publication statusPublished - Oct 1 2018

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Urinary Bladder Neoplasms
Bacillus
Disease-Free Survival
Mycobacterium bovis
Recurrence
Neoplasms
Proportional Hazards Models
Survival Rate
Therapeutics
Population

Keywords

  • BCG vaccine
  • Treatment outcome
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Long-term outcomes of high-grade T1 bladder cancer treated with intravesical bacillus Calmette-Guérin : Experience of a single center. / Hurle, Rodolfo; Buffi, Nicolò; Lista, Giuliana; Cardone, Pasquale; Forni, Giovanni; Maffei, Davide; Peschechera, Roberto; Zandegiacomo, Silvia; Pasini, Luisa; Benetti, Alessio; Colombo, Piergiuseppe; Lazzeri, Massimo; Casale, Paolo; Guazzoni, Giorgio; Lughezzani, Giovanni.

In: Minerva Urologica e Nefrologica, Vol. 70, No. 5, 01.10.2018, p. 501-508.

Research output: Contribution to journalArticle

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abstract = "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 (RF S) and progression-free survival (PFS), as well as the predictors of RF S 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/CI S, 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/CI S, while 10 (45.5{\%}) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RF S 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.",
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T1 - Long-term outcomes of high-grade T1 bladder cancer treated with intravesical bacillus Calmette-Guérin

T2 - Experience of a single center

AU - Hurle, Rodolfo

AU - Buffi, Nicolò

AU - Lista, Giuliana

AU - Cardone, Pasquale

AU - Forni, Giovanni

AU - Maffei, Davide

AU - Peschechera, Roberto

AU - Zandegiacomo, Silvia

AU - Pasini, Luisa

AU - Benetti, Alessio

AU - Colombo, Piergiuseppe

AU - Lazzeri, Massimo

AU - Casale, Paolo

AU - Guazzoni, Giorgio

AU - Lughezzani, Giovanni

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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 (RF S) and progression-free survival (PFS), as well as the predictors of RF S 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/CI S, 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/CI S, while 10 (45.5%) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RF S 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.

AB - 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 (RF S) and progression-free survival (PFS), as well as the predictors of RF S 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/CI S, 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/CI S, while 10 (45.5%) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RF S 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.

KW - BCG vaccine

KW - Treatment outcome

KW - Urinary bladder neoplasms

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