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 

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Reference: 
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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