MP63-19 ADEQUATE VS INADEQUATE BCG INTRAVESICAL THERAPY IN INTERMEDIATE AND HIGH RISK NMIBC: TOTAL NUMBER OF INSTILLATIONS IS WHAT REALLY MATTERS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP63-19 ADEQUATE VS INADEQUATE BCG INTRAVESICAL THERAPY IN INTERMEDIATE AND HIGH RISK NMIBC: TOTAL NUMBER OF INSTILLATIONS IS WHAT REALLY MATTERS Mario DE Angelis, Francesco Pellegrino, Mattia Longoni, Pietro Scilipoti, Chiara Re, Alessandro Bertini, Umberto Capitanio, Andrea Salonia, Giorgio Gandaglia, Riccardo Leni, Francesco Montorsi, Alberto Briganti, and Marco Moschini Mario DE AngelisMario DE Angelis More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Mattia LongoniMattia Longoni More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Chiara ReChiara Re More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , and Marco MoschiniMarco Moschini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) is currently recommended by EAU guidelines for proper treatment of patients with intermediate (IR) and high risk (HR) non-muscle invasive bladder cancer (NMIBC). We aimed to verify if complete adherence to BCG therapy relates to better oncological outcomes in terms of risk of recurrence and progression METHODS: We retrospectively identified 250 patients who underwent transurethral resection of bladder cancer between 2012 and 2022 at a tertiary referral centre. All these patients were diagnosed with IR or HR NMIBC and treated with BCG according to EAU guidelines. We evaluated if intravesical treatment was adequate, defined as at least 1 year of maintenance in IR patients and 3 years in HR patients. Multivariable analyses (MVA) tested the impact of number of instillations and therapy adequateness on recurrence and progression. Recurrence and progression were compared with the Kaplan-Meier (KM) analysis according to intravesical therapy adequateness RESULTS: 45 patients (18%) received adequate intravesical therapy according to their class of risk. Patients with adequate treatment received about triple the amount of instillations compared with inadequately treated ones (21 vs 9). Median FU was 42 months. In this period, 75 patients showed disease recurrence, 62 of which were treated inadequately (83%). Similarly, 93% of progressions concerned patients treated inadequately. At MVA, both total number of instillations and proper treatment were related with disease progression (HR 0.92, p=0.015 vs HR 0.22, p=0.041). Conversely, recurrence was only associated with total number of instillation (HR 0.95, p=0.019). KM analysis shows how at 2 years follow-up, progression free survival was higher in patients who received adequate treatment compared with those treat inadequately (96%vs 83%) CONCLUSIONS: A more intense BCG instillation regime is associated with lower risk of recurrence and progression of bladder cancer. In particular, a higher amount of instillations seems to be more related with tumor recurrence and progression. These results confirm the hypothesis that too often real life differ from guidelines, resulting in an actual undertreatment of these patients and the consequent worsening of the disease. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e879 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mario DE Angelis More articles by this author Francesco Pellegrino More articles by this author Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Chiara Re More articles by this author Alessandro Bertini More articles by this author Umberto Capitanio More articles by this author Andrea Salonia More articles by this author Giorgio Gandaglia More articles by this author Riccardo Leni More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF downloadLoading ...