1740 RETROSPECTIVE STUDY OF DIFFERENT OPTIONS IN THE MANAGEMENT OF NON-MUSCLE INVASIVE BLADDER CANCER T1G3: MAINTENANCE BCG IS HERE TO STAY

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20111740 RETROSPECTIVE STUDY OF DIFFERENT OPTIONS IN THE MANAGEMENT OF NON-MUSCLE INVASIVE BLADDER CANCER T1G3: MAINTENANCE BCG IS HERE TO STAY Juan Palou, Eduardo Solsona, J. Angulo, Jesús María Fernández, Miguel Unda, and L.M. Piñeiro Juan PalouJuan Palou Barcelona, Spain More articles by this author , Eduardo SolsonaEduardo Solsona Valencia, Spain More articles by this author , J. AnguloJ. Angulo Madrid, Spain More articles by this author , Jesús María FernándezJesús María Fernández Madrid, Spain More articles by this author , Miguel UndaMiguel Unda Madrid, Spain More articles by this author , and L.M. PiñeiroL.M. Piñeiro Madrid, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2067AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of T1G3 non-muscle invasive bladder cancer (NMIBC) has evolved during the last 20 years but recurrence and progression remain the main concerns. The introduction of intravesical Bacillus Calmette-Guerin (BCG) with different doses and number of doses is still under debate. Good first TUR and Re-TUR has become standart of care in high grade NMIBC in order to improve clinical staging and otucomes by decreasing understaging and residual disease. To evaluate, in a large retrospective series of patients, the differences in recurrence, progression to invasive disease and cancer specific survival according to the different treatments received in the different periods before and after the introduction of BCG. METHODS This is a retrospective analysis of 1039 patients with primary and recurrent stage T1G3 NMIBC including 945 males (mean age of 66.5, b9.8 years, range 21–89). All underwent a complete TUR with multiple bladder biopsies, with muscle present in the specimen. All of them were treated conservatively as follows: 1) no BCG, 2) Re-TUR only, 3) BCG Connaught 27 mgrs induction course, 4) BCG Connaught 81 mgrs induction course, 5) BCG Connaught 81 mgrs induction course + maintenance. There were no differences on the distribution in the groups except that patients with CIS and recurrent tumours were treated more frequently with BCG (p<0.001). We evaluate the time to first recurrence, progression to a higher stage (T2 or greater, or metastatic disease), disease specific mortality. Time to event was estimated with Kaplan Meier and then compared using the logrank test and the multivariate Cox proportional hazards regression model. RESULTS The following results were observed with a median followup of 62±39 months. CONCLUSIONS BCG treatment with maintenance offers the best results in recurrence, progression and disease specific survival in patients with stage T1G3 bladder cancer. Full dose BCG is better than one third dose related to the same parameters. There is an important difference in recurrence rate between the patients treated with or wihout BCG. Full dose BCG treatment reduces progression to invasive disease. Disease specific mortality is better in those patients treated with BCG. Despite being a retrospective study, the large number of patients offers an overview of the impact of the different conservative modalities in patients with T1G3 NMIBC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e698-e699 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Palou Barcelona, Spain More articles by this author Eduardo Solsona Valencia, Spain More articles by this author J. Angulo Madrid, Spain More articles by this author Jesús María Fernández Madrid, Spain More articles by this author Miguel Unda Madrid, Spain More articles by this author L.M. Piñeiro Madrid, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...