Journal article
The association of salvage intravesical therapy following BCG with pathologic outcomes and survival after radical cystectomy for patients with high-grade non-muscle invasive bladder cancer: A multi-institution analysis
Urologic oncology, Vol.39(7), pp.436.e1-436.e8
07/2021
DOI: 10.1016/j.urolonc.2021.01.004
PMID: 33485764
Abstract
•A total of 378 patients with high grade NMIBC received BCG and underwent cystectomy.•A total of 62 patients received additional salvage therapy (ST).•ST was not associated with increased risk of adverse pathology at cystectomy.•On multivariable analysis ST was not associated with CSS.•In carefully selected patients ST does not worsen oncologic outcomes.
While numerous current clinical trials are testing novel salvage therapies (ST) for patients with recurrent nonmuscle invasive bladder cancer (NMIBC) after bacillus Calmette-Guérin (BCG), the natural history of this disease state has been poorly defined to date. Herein, we evaluated oncologic outcomes in patients previously treated with BCG and ST who subsequently underwent radical cystectomy (RC).
We identified 378 patients with high-grade NMIBC who received at least one complete induction course of BCG (n = 378) with (n = 62) or without (n = 316) additional ST and who then underwent RC between 2000 and 2018. Oncologic outcomes were compared using the Kaplan-Meier method and Cox proportional hazards models. Sensitivity analyses were conducted stratifying by presenting tumor stage, matched 1:3 for receipt vs. no receipt of ST.
Patients receiving ST were more likely to initially present with CIS (26% vs. 17%) and less likely with T1 disease (34% vs. 50%, P = 0.06) compared to patients not treated with ST. Receipt of ST was not associated with increased risk of adverse pathology (≥pT2 or pN+) at RC (31% vs. 41%, P = 0.14). Likewise, 5-year cancer-specific survival did not significantly differ between groups on univariable Kaplan-Meier analysis (73% for ST and 74% for no ST, P = 0.7). Moreover, on multivariable analysis, receipt of ST was not significantly associated the risk of death from bladder cancer (HR 1.12; 95% CI 0.60–2.09, P = 0.7). Results were unchanged on sensitivity analysis.
These data suggest that, in carefully selected patients, ST following BCG for high grade NMIBC does not compromise oncologic outcomes for patients who ultimately undergo RC.
Details
- Title: Subtitle
- The association of salvage intravesical therapy following BCG with pathologic outcomes and survival after radical cystectomy for patients with high-grade non-muscle invasive bladder cancer: A multi-institution analysis
- Creators
- Vignesh T. Packiam - University of IowaCraig V. Labbate - University of ChicagoStephen A. Boorjian - Mayo Clinic in ArizonaRobert Tarrell - Mayo Clinic in FloridaJohn C. Cheville - Mayo ClinicSvetlana Avulova - Department of Urology Mayo Clinic Rochester MNVidit Sharma - Mayo ClinicMatvey Tsivian - Mayo Clinic in ArizonaBrittany Adamic - University of ChicagoMohammad Mahmoud - University of ChicagoRyan P. Werntz - Prisma HealthNorm D. Smith - NorthShore University HealthSystemR. Jeffrey Karnes - Department of Urology Mayo Clinic Rochester MNMatthew K. Tollefson - Mayo Clinic in ArizonaGary D. Steinberg - New York UniversityIgor Frank - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.39(7), pp.436.e1-436.e8
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urolonc.2021.01.004
- PMID
- 33485764
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Language
- English
- Date published
- 07/2021
- Academic Unit
- Urology
- Record Identifier
- 9984319980802771
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