Abstract
Guidelines change every few years regarding the prophylactic use of Bacille Calmette-Guérin (BCG) against non-muscle invasive bladder cancer. We performed a retrospective comparison to clarify the differences in BCG efficacy, based on time period, between Japan and Western countries . Published literature on 18 Japanese and 28 Western patient studies were compared to evaluate differences in BCG efficacy. Additionally, Internet searches were performed to obtain comparative Japanese and Western data. BCG efficacy in Japanese literature tended to show decreasing non-recurrence rates by time period. Non-recurrence rates in Western countries increased each year. This discrepancy may stem from a number of factors, including changes in accepted BCG indications, the introduction of restaging transurethral resection (re-TUR), the concept of BCG maintenance, and the evolution of histopathological diagnostic criteria.
Highlights
For the past two decades, intravesical Bacille Calmette-Guérin (BCG) instillation therapy has been considered the worldwide gold standard for the treatment of non-muscle invasive bladder cancer (NMIBC) [1–3]
Two major sets of guidelines were published by the European Association of Urology (EAU) [2] and the National Comprehensive Cancer Network (NCCN)
All literature was identified via PubMed database searches, which were limited to human subjects and contained the MeSH term “bladder neoplasms” with additional search terms “BCG” or “bacillus Calmette-Guérin” and “Japan.” Additional searches were conducted on the Japanese electronic database JAPIC (Japan Pharmaceutical Information Center)
Summary
For the past two decades, intravesical Bacille Calmette-Guérin (BCG) instillation therapy has been considered the worldwide gold standard for the treatment of non-muscle invasive bladder cancer (NMIBC) [1–3]. There were no generally accepted guidelines or risk classifications. The first guidelines for BCG indication were published in 1999 by the American Urological Association (AUA) [1]. Two major sets of guidelines were published by the European Association of Urology (EAU) [2] and the National Comprehensive Cancer Network (NCCN). Guidelines for the prophylactic use of BCG against NMIBC have been revised due to modifications in the pathological diagnostic classifications, the introduction and consensus regarding restaging transurethral resection (re-TUR) procedures [3, 4, 5], and other technical or mechanical improvements. We conducted a retrospective comparison to clarify differences in BCG efficacy, according to time period, between patients in Japan and Western countries
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