Abstract
ObjectiveTo investigate the association between antibiotic therapy and the efficacy of intravesical BCG therapy in patients with high-risk non-muscle invasive bladder cancer (NMIBC).MethodsThis study involved the retrospective review of medical records of patients who underwent transurethral resection of bladder tumors for high-risk NMIBC followed by intravesical BCG therapy between 2008 and 2017. Patients were categorized as none, short- (2-6 days), and long-course use (≥7 days) based on the duration of antibiotic treatment concurrent with or initiated ≤30 days before BCG therapy. Oncologic outcomes, including recurrence-free survival and progression-free survival, were analyzed.ResultsOf the 276 patients enrolled in the study, 162 (58.7%) had pathologic T1 disease and 206 (80.2%) had high-grade disease. Concurrently with or prior to BCG therapy, 114 patients had (41.3%) received short-course antibiotic therapy, and 96 (34.8%) patients had received long-course antibiotics. The 5-year recurrence-free survival (62.2% vs 26.9%; log rank, p <0.001) and progression-free survival (79.6% vs. 53.3%; log rank, p=0.001) rates were significantly higher in patients who did not receive antibiotic therapy than in those treated with long-course antibiotics. Multivariable analysis revealed that antibiotic treatment for more than 7 days was independently associated with increased risks of recurrence (hazard ratio [HR], 2.45; 95% confidence interval [CI], 1.49-4.05; p < 0.001) and progression (HR, 3.68; 95% CI, 1.65-8.22 p = 0.001).ConclusionLong-course antibiotic treatment concurrently with or prior to intravesical BCG adversely influenced disease recurrence and progression outcomes in patients with high-risk NMIBC. Careful use of antibiotics may be required to enhance the efficacy of intravesical BCG therapy. Further mechanistic and prospective studies are warranted.
Highlights
Non-muscle invasive bladder cancer (NMIBC), which is confined to the mucosa (Ta or carcinoma in situ, CIS) or submucosa (T1), accounts for 75% of new cases of bladder cancer [1]
Intravesical Bacillus Calmette–Guérin (BCG) instillation, which has been used in the treatment of NMIBC for more than 40 years, is superior to intravesical chemotherapy, in terms of disease recurrence and progression, for intermediate- and high-risk NMIBC [3]
We found that long-course antibiotic therapy was independently associated with recurrence and progression following intravesical BCG therapy in patients with high risk NMIBC
Summary
Non-muscle invasive bladder cancer (NMIBC), which is confined to the mucosa (Ta or carcinoma in situ, CIS) or submucosa (T1), accounts for 75% of new cases of bladder cancer [1]. The probability of 5-year recurrence of NMIBC is high, ranging from 31% to 78% according to risk stratification [1]. Intravesical Bacillus Calmette–Guérin (BCG) instillation, which has been used in the treatment of NMIBC for more than 40 years, is superior to intravesical chemotherapy, in terms of disease recurrence and progression, for intermediate- and high-risk NMIBC [3]. In case of BCG-unresponsive high-risk NMIBC, radical cystectomy with pelvic lymph node dissection and urinary diversion is the standard treatment. This procedure is associated with significant morbidity and mortality, and poor health-related quality of life [5].
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