Factors Associated with Recurrence in Primary Carcinoma in situ of the Bladder Treated with Bacillus Calmette-Guérin - Expert Commentary

Primary carcinoma in situ (P-CIS) of the bladder is rare. Adjuvant intravesical Bacillus Calmette-Guérin (BCG) immunotherapy has been reported to be effective in reducing recurrence rates in CIS and P-CIS patients but the clinical factors associated with the recurrence of P-CIS are not well-defined. 

A retrospective study published by Kim et al. evaluated the contribution of various factors on the on clinical outcomes of P-CIS patients who received BCG treatment. The authors reviewed the medical records of 5,945 patients between 1999 and 2014 including 64 patients with P-CIS who completed 6+ cycles of BCG treatment. 

The authors found that older P-CIS patients had a higher recurrence after BCG therapy. Patients who had no gross hematuria at the time of diagnosis also had a higher recurrence rate than those with gross hematuria. On the other hand, the authors found that patients who were diagnosed with hypertension and taking anti-hypertensive drugs had a lower recurrence rate than those not taking anti-hypertensive drugs. When compared different anti-hypertensive drugs, they found that patients who are taking ACEIs/ARBs have fewer recurrences than other types of antihypertensive medications.  Smoking status or urine cytology did not significantly affect the recurrence-free survival after BCG treatment. The authors speculate that  this may be the effect of ARB on the angiotensin II type I receptor (AT1R) which affects. tumor growth and angiogenesis.  

The study is limited by the small number of P-CIS cases and these results should be considered hypothesis-generating. Understanding the biological features that determine the clinical course of P-CIS deserves more study.

Written by: Bishoy M. Faltas, MD, Weill Cornell Medicine, New York, NY 

Read the Abstract

Kim SJ, Nam W, You D, Jeong IG, Song C, Hong B, Kim CS, Ahn H, Hong JH.  Urol Int. 2018 Sep 4:1-8. doi: 10.1159/000492121.Urol Int. 2018 Sep 4:1-8. doi: 10.1159/000492121.
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