Abstract
Non-muscle-invasive bladder cancer (NMIBC) is categorized into high-risk and low-risk groups. Although, bacillus Calmette-Guerin (BCG) is the recommended adjuvant therapy of high-risk bladder tumor, optimal schedule (induction versus maintenance) of this therapy is a subject of debate. The objective was to evaluate outcomes of induction BCG in high-risk NMIBC patients at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan and retrospective cohort study conducted in the department of urology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan. Three-year disease-free survival and progression-free survival was the main outcome measure. Data of 68 high-risk (Ta and T1 with G3 or high-grade subtype) bladder cancer patients who underwent transurethral resection followed by six-weekly intravesical BCG instillation was included in the study. Recurrence was described as biopsy-proven bladder cancer; whereas the presence of muscle invasion was considered as progression. Disease-free survival and progression-free survival were defined as time intervals elapsed between the starting date of BCG instillation and recurrence or progression, respectively. Kaplan-Meier curve was employed to estimate the three-year study end-points. Disease-free survival at three years was observed to be 66.2% and progression-free survival at 86.8%. The use of induction BCG alone for high-risk patients of NMIBC is a viable option both in terms of effective disease-free and progression-free survival rates.
Highlights
Transitional cell carcinoma (TCC), the commonest type of bladder cancer, has a heterogeneous clinical spectrum, disease progression, therapeutic modalities and prognosis [1]
On the basis of histopathology, superficial lesions are stratified from papillary urothelial neoplasms of low malignant potential (PUNLMP) to high-grade urothelial carcinomas, whereas morphologically, they are separated into three subtypes: papillary tumors
Clinical information of all patients of both sexes who underwent transurethral resection followed by intravesical bacillus Calmette-Guerin (BCG) induction therapy between January 2008 to December 2012 having following parameters were included in the study: Ta and T1 tumor categories, high-grade, between 50 to 80 years of age
Summary
Transitional cell carcinoma (TCC), the commonest type of bladder cancer, has a heterogeneous clinical spectrum, disease progression, therapeutic modalities and prognosis [1]. On the basis of histopathology, superficial lesions are stratified from papillary urothelial neoplasms of low malignant potential (PUNLMP) to high-grade urothelial carcinomas, whereas morphologically, they are separated into three subtypes: papillary tumors. As these tumors are amenable to transurethral resection, they are categorized as non-muscleinvasive bladder cancer (NMIBC) [4]
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