Journal article
Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer
BJU international, Vol.135(2), pp.260-268
02/2025
DOI: 10.1111/bju.16509
PMCID: PMC11745998
PMID: 39183466
Abstract
To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).OBJECTIVETo quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.PATIENTS AND METHODSPre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).RESULTSAmong 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.CONCLUSIONIn a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.
Details
- Title: Subtitle
- Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer
- Creators
- Jacob I Taylor - The University of Texas Southwestern Medical CenterAshish M Kamat - The University of Texas MD Anderson Cancer CenterMichael A O'DonnellDrupad Annapureddy - The University of Texas Southwestern Medical CenterJeffrey Howard - The University of Texas Southwestern Medical CenterWei Shen Tan - The University of Texas MD Anderson Cancer CenterIan McElree - University of IowaFacundo Davaro - Moffitt Cancer CenterKendrick Yim - Brigham and Women's HospitalStephen Harrington - Penn State Milton S. Hershey Medical CenterElizabeth Dyer - Penn State Milton S. Hershey Medical CenterAnna J Black - University of British ColumbiaPratik Kanabur - Baylor College of MedicineMathieu Roumiguié - Institut universitaire du cancer de Toulouse OncopoleSeth Lerner - Baylor College of MedicinePeter C Black - University of British ColumbiaJay D RamanMark A Preston - Brigham and Women's HospitalGary Steinberg - NYU Langone HealthWilliam Huang - NYU Langone HealthRoger Li - Moffitt Cancer CenterVignesh T Packiam - University of IowaSolomon L Woldu - The University of Texas Southwestern Medical CenterYair Lotan - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- BJU international, Vol.135(2), pp.260-268
- DOI
- 10.1111/bju.16509
- PMID
- 39183466
- PMCID
- PMC11745998
- NLM abbreviation
- BJU Int
- ISSN
- 1464-410X
- eISSN
- 1464-410X
- Publisher
- WILEY
- Grant note
None.
- Language
- English
- Electronic publication date
- 08/25/2024
- Date published
- 02/2025
- Academic Unit
- Urology
- Record Identifier
- 9984699522102771
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