The Timing of Radical Cystectomy for BCG Failure: Comparison of Outcomes and Risk Factors for Prognosis

PURPOSE - We compared the pathologic and survival outcomes of patients who underwent radical cystectomy soon after Bacillus Calmette-Guerin (BCG) failure with those who received additional salvage intravesical chemotherapy prior to undergoing cystectomy for non-muscle-invasive bladder cancer.

In addition, we identified predictors of prognosis for the entire cohort.

MATERIALS AND METHODS - We retrospectively analyzed 117 patients who underwent radical cystectomy from 1990 to 2012 at our institution for recurrent non-muscle-invasive bladder cancer. The cohort was separated into two groups: Group 1 (n = 61) was comprised of patients treated only with BCG +/- interferon-α; group 2 (n = 56) received at least one additional salvage intravesical chemotherapy after BCG.

RESULTS - Final pathology and survival outcomes did not differ significantly amongst groups. 5-year overall and cancer specific survival was similar for both groups at 80% and 85%, respectively, with roughly equivalent follow-up time. Median bladder retention was 1. 7 years longer for group 2 (p <0. 001). On multivariate Cox regression analysis, delayed cystectomy (group 2) did not convey a significant hazard for all-cause mortality after cystectomy (HR 1. 08, p = 0. 808); only upstaging to cT1 (HR 1. 88, p = 0. 045), LVI (HR 2. 58, p = 0. 023), and prostatic urethra involvement (HR 1. 95, p = 0. 029) achieved significance.

CONCLUSIONS - With appropriate patient selection for salvage intravesical chemotherapy, patients who elect bladder sparing treatment in lieu of earlier radical cystectomy after failing BCG do not sacrifice pathologic or oncologic outcomes while retaining bladder function for a significantly longer duration.

The Journal of urology. 2016 Jan 22 [Epub ahead of print]

Christopher R Haas, LaMont J Barlow, Gina M Badalato, G Joel DeCastro, Mitchell C Benson, James M McKiernan

Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York. Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York. , Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York. , Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York. , Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York. , Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, Department of Urology, New York, New York.

PubMed