Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) is a newly defined subtype that is unlikely to benefit from BCG rechallenge. Radical cystectomy is currently recommended for BCG-unresponsive NMIBC; however, a certain proportion of these patients can be managed with treatments other than that. Herein, we conducted a multicenter retrospective study to analyze the clinical outcomes of BCG-unresponsive NMIBC patients who did not receive radical cystectomy.
Of the 141 BCG-unresponsive NMIBC patients, 94 (66.7%) received treatment except radical cystectomy. Survival outcomes were calculated from the date of diagnosis using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors were identified using the multivariate Cox regression model. This group was further classified into three groups according to the number of risk factors, and survival outcomes were compared.
Multivariate analyses identified low estimated glomerular filtration rate (< 45 ml/min/1.73 m2) and large tumor size (≥ 30 mm) before BCG induction as independent poor prognostic factors for progression-free survival and overall survival, while the latter was also an independent factor for cancer-specific survival. The presence of variant histology was an independent poor prognostic factor for overall survival. The high-risk non-cystectomy group showed a significantly poor prognosis for progression-free survival (hazard ratio: 7.61, 95% confidence interval: 2.11-27.5), cancer-specific survival (10.4, 0.54-70.02), and overall survival (8.28, 1.82-37.7).
Our findings suggest that patients with renal impairment and large tumors should undergo radical cystectomy if the complications and intentions of the patients allow so.
International journal of clinical oncology. 2021 Jul 27 [Epub ahead of print]
Kota Iida, Makito Miyake, Kaoru Murakami, Motokiyo Komiyama, Eijiro Okajima, Tomokazu Sazuka, Naotaka Nishiyama, Hiroaki Yasumoto, Takahiro Kimura, Akihiro Ito, Kenichiro Shiga, Atsushi Yamagishi, Hiroshi Kikuchi, Mikio Sugimoto, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Hiroshi Kitamura, Hiroyuki Nishiyama, Kiyohide Fujimoto
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan., Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. ., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, National Cancer Center Hospital, Tokyo, Japan., Department of Urology, Nara City Hospital, Nara, Japan., Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan., Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan., Department of Urology, Shimane University, Izumo, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Tohoku University School of Medicine, Aoba-ku, Sendai, Miyagi, Japan., Department of Urology, Harasanshin Hospital, Fukuoka, Japan., Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan., Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan., Department of Urology, Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan., Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.