Abstract
To evaluate the influence of patient-associated parameters and comorbities, with a special focus on renal function after intravesical adjuvant bacillus Calmette-Gue´rin (BCG) immunotherapy in patients with non–muscle-invasive bladder cancer (NMIBC). We retrospectively reviewed the medical records of patients treated from October, 1991 to December, 2013 at Seoul National University who were diagnosed with NMIBC and treated with intravesical BCG. A total of 344 patients who were diagnosed with NMIBC and treated with intravesical BCG were enrolled in this study. Tumor recurrence was observed in 171 patients (49.3%); progression to higher pT category or grade was found in 68 patients (15.1%). Multivariate analysis demonstrated that recurrent tumors and the presence of multiple tumors increased the risk of recurrence. However, other factors also appeared to predict recurrence, such as impaired renal function (<60 ml/min), which was associated with recurrence in univariate and multivariate analyses (HR 1.879 p = 0.008). It is worthy of notice that impaired renal function was an independent predictor of tumor recurrence after BCG instillation in multivariate analysis. Therefore, we should consider not only the clinical or pathologic findings of a tumor but also renal function during decision-making for additional therapy.
Highlights
80% of all newly-diagnosed bladder cancers are found to be non–muscle invasive[1, 2]
The complete response rate to bacillus Calmette-Guerin (BCG) therapy in patients with high-risk non–muscle-invasive bladder cancer (NMIBC) can be as high as 83.8%; most patients with high-risk disease suffer from recurrence[5]
In CUETO trials, authors concluded that female gender, history of recurrence, multiplicity, and presence of associated CIS are significant independent predictors for recurrence after BCG instillation[9]
Summary
Medical records were reviewed for tumor category and grade, presence of comorbidities, and putative preoperative risk factors (Hemoglobin, C-reactive protein (CRP) level, eGFR, age at diagnosis, and gender). Patients with visible tumors underwent complete transurethral bladder resection and were staged according to the 1987 TNM classification and the World Health Organization 1973 grading system. Follow-up of patients was performed in an outpatient setting according to the contemporary guidelines (European Association of Urology Guidelines). When a patient showed pathological progression by either upstaging or upgrading, tumor progression was recorded. Logistic regression analysis and Chi square tests were performed to assess individual risk factors. Parameter Age, Yr 70 HTN DM Gender Male Female No of tumors 1 2–7 7< Tumor size 3Cm T category Ta T1 Associated CIS No Yes eGFR 60 ml/min BCG Initial instillation 6> BCG maintenance. The p value was considered statistically significant if it was less than 0.05
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