Predictive factors of failure of BCG therapy in high-level superficial bladder tumors

Abstract

Introduction High-grade bladder tumors are superficial, poorly differentiated, they are characterized by there architectural disorganization and marked cytologic abnormalities. The treatment of superficial tumors of the bladder has a twofold objective: the first one is to reduce the frequency of local recurrences and, on the second one is to prevent progression towards muscular infiltration. Hence, the indication of the adjuvant treatment to the transurethral resection of the bladder. The purpose of our work is to study the predictive factors for the failure of intravesical BCG instillations in the management of these tumors. Failure was defined by the progression or recurrence of superficial high-grade bladder tumors. Material and method We undertook in this work a retrospective descriptive study, including 80 patients who were treated in the urology department “A” at the RABAT CHU for high-grade urothelial carcinoma PTa and PT1 between January 2010 and June 2013. Rates of recurrence, progression after BCG therapy were studied. The prognostic factors associated with this type of tumor were then sought after by Cox regression. The overall average decline in the study was 50 months or about 4.5 years. Results The patients were 71 men and 9 women. The average age of our patients was 60 years old with extremes ranging from 38 to 71 years old. At 50 months, 60% of patients treated with BCG therapy are free from recurrence. This rate is 69% for PTa tumors and 53% for pT1 tumors ( P = 0.03); 22 (27%) patients had a recurrence under the same histological grade in the first 24 months, 11 (13%) patients had tumor progression, 4 of which were infiltrating cystectomy treated. In univariate analysis, the significantly identified risk factors for recurrence were: multifocal lesions ( P = 0.001), presence of associated in situ carcinoma, vascular invasion ( P P = 0.001), and the lack of maintenance therapy with BCG therapy. The risk factors for progression were: the presence of CIS, the crossing of the lamina propria especially in PT1G3 tumors, and the size greater than 5 cm. In multi-varied analysis, the presence of CIS, crossing the lamina propria and the tumor size in case of tumor PT1G3 are the significant factors of the failure of BCG therapy ( P = 0.001). The primary or secondary character of the high histological grade of tumor, patient age and multifocality ( P = 0.4) were not significant. This multi-varied study also showed a strong correlation between tumor size and invasion of the lamina propria. Conclusion The results of this retrospective study suggest that high-grade tumors must be compulsorily controlled by BCG therapy with a maintenance protocol. This study also made it possible to select patients with very high-risk of recurrence and progression after BCG therapy who should receive close monitoring and cystectomy if BCG therapy fails.