Patients with High Grade Bladder Cancer, and Tumor-Free 3 and 6-Month Cystoscopy after bacillus Calmette-Guérin have a Good Prognosis without Further Maintenance bacillus Calmette-Guérin

Abstract

IntroductionThe benefit of 3 years of maintenance bacillus Calmette-Guérin has been questioned. The outcome is reported for bacillus Calmette-Guérin treated patients who had negative 3 and 6-month cystoscopy results and were subsequently not treated with maintenance bacillus Calmette-Guérin. MethodsA retrospective, population based study of patients with high grade nonmuscle invasive bladder cancer treated with bacillus Calmette-Guérin was performed. Patients were included in analysis who had tumor-free cystoscopy findings 3 and 6 months after the start of treatment. No patient was treated with maintenance bacillus Calmette-Guérin after the 6-month cystoscopy. The Kaplan-Meier estimated 5-year survival rates were calculated. ResultsThree and 6-month cystoscopy revealed no tumor in 196 patients with a median age of 72 years. Of the patients 84% had carcinoma in situ or multiple and/or recurrent high grade tumors. Five-year recurrence-free, progression-free and disease specific survival was 69%, 95% and 98%, respectively. Median followup in 119 patients who were alive at the last contact was 79 months. Recurrence developed in 62 of 196 patients (32%), disease stage progressed to at least T2 in 13 (7%) and 7 (3%) died of bladder cancer. ConclusionsPatients without maintenance bacillus Calmette-Guérin after tumor-free 3 and 6-month cystoscopy have a low rate of progression and bladder cancer death. An alternative to 1 to 3 years of bacillus Calmette-Guérin maintenance may be no maintenance after the second tumor-free cystoscopy with re-treatment with bacillus Calmette-Guérin in case of recurrence.