AUA 2022: Immediate Radical Cystectomy vs. BCG Immunotherapy for T1 High Grade Non-Muscle-Invasive Bladder Cancer: an International Multicentre Collaboration

(  The 2022 Annual Meeting of the American Urological Association was host to a moderated poster session for non-invasive bladder cancer. Dr. Chiara Lonati presented the results of a retrospective analysis comparing the cancer-specific mortality (CSM) and overall mortality (OM) between T1 squamous bladder cancer patients undergoing immediate radical cystectomy versus conservative treatment with BCG.


The study included retrospective data on 188 patients with T1 high-grade squamous cell bladder cancer treated between 1998 and 2019 at fifteen tertiary referral centers. CSM and OM were evaluated using the cumulative incidence and Kaplan-Meier curves and statistical significance tested using the Pepe-Mori and log-rank tests. Multivariable regression models, adjusted for pathological findings at initial transurethral resection of bladder specimen, were used to assess predictors of umour recurrence and progression after BCG immunotherapy.

Median follow-up time was 36 months (interquartile range: 19-76). Of the 188 patients, 20% underwent immediate RC and 80% conservative therapy with BCG. There were no statistically significant differences in the 5-year CSM and OM between the two groups (Pepe-Mori test p=0.052 and log-rank test p=0.2, Fig. 1A and 1B respectively).


Among BCG-treated patients, tumor recurrence was observed in 41% of individuals (median time: 8 months), while tumour progression was reported in 24% of patients (median time: 19 months).


On multivariable Cox analyses, predictors of tumor progression included:

  • Pure squamous cell carcinoma: HR 2.40, p=0.04
  • Concomitant lymphovascular invasion: HR: 2.19, p=0.04
    • Also predictor of recurrence: HR 1.94, p=0.04


Patients with neither pure SqCC nor LVI showed a significant benefit in three-year recurrence-free survival and progression-free survival compared to individuals with pure SqCC or LVI (60% vs. 44%; log-rank p=0.04 and 80% vs. 68%; log-rank p=0.004, Fig. 1C and 1D respectively).



The authors concluded that BCG could represent an effective treatment for T1 squamous BCa patients with neither pure SqCC nor LVI, while immediate RC should be prioritized among T1 squamous BCa patients with pure SqCC or LVI at initial TURB specimen.


Presented By: Chiara Lonati, MD, PhD, Resident Physician, Department of Urology, Spedali Civili di Brescia, Italy

Written By: Rashid Sayyid, MD, MSc – Urology Chief Resident, Augusta University/Medical College of Georgia, @rksayyid on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.