You have accessJournal of UrologyBladder Cancer: Non-Invasive I1 Apr 2016MP13-17 CHARACTERIZING INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR THE DEFINITION OF INTERMEDIATE RISK AND TREATMENT STRATEGY Kazuhiro Matsumoto, Eiji Kikuchi, Yoshinori Yanai, Nozomi Hayakawa, Yujiro Ito, Takahiro Maeda, Hirohiko Nagata, Akira Miyajima, and Mototsugu Oya Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Yoshinori YanaiYoshinori Yanai More articles by this author , Nozomi HayakawaNozomi Hayakawa More articles by this author , Yujiro ItoYujiro Ito More articles by this author , Takahiro MaedaTakahiro Maeda More articles by this author , Hirohiko NagataHirohiko Nagata More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2498AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Risk stratification of low, intermediate, and high risk has been widely applied to predict the prognosis and guide additional treatment for non-muscle invasive bladder cancer (NMIBC). Although low- and high-risk categories are clearly defined, the intermediate-risk category has traditionally been composed of all patients not included in either of these categories. Therefore, intermediate-risk disease consists of a heterogeneous group of patients. METHODS We reviewed and focused on 326 patients diagnosed with intermediate-risk NMIBC. We sub-classified these heterogeneous patients into three groups according to their clinical courses. Group A included patients with initial and multiple low-grade tumors (N=170). Group B consisted of cases with low-grade tumor which recurred after low-risk tumor (N=97), and Group C was composed of recurrent low-grade cases after high-risk tumor (N=59). RESULTS The 5-year recurrence-free survival rate was significantly lower in Group C (40%) than that in Group A (53%, p<0.01) and Group B (51%, p<0.01). Regarding the 5-year progression-free survival rate, significant differences were not observed among the groups (88%, 89%, and 91% in Groups A, B, and C, respectively). Totally, 167 patients received adjuvant bacille Calmette-Guerin (BCG) instillation and 39 received adjuvant chemo instillation. In Groups A and B, there was not a significant difference in the efficiency against tumor recurrence between BCG and chemo instillations. On the other hand, in Group C, the 5-year recurrence-free survival rates were 65% in patients receiving BCG therapy and 25% in those receiving chemotherapy, and the difference was significant (p=0.01, Figure 1). Furthermore, Group C included 11 BCG refractory cases, and 5 of them later experienced stage progression during follow-up. CONCLUSIONS Our sub-classification analyses indicated that intermediate-risk tumors which recurred after high-risk tumor (Group C) should be treated with adjuvant BCG therapy because of the high probability of subsequent recurrence. In addition, the definition of intermediate risk can include some BCG refractory cases. To provide prognostically useful information, the best method of risk stratification in the intermediate-risk group awaits future clinical outcome studies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e141 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kazuhiro Matsumoto More articles by this author Eiji Kikuchi More articles by this author Yoshinori Yanai More articles by this author Nozomi Hayakawa More articles by this author Yujiro Ito More articles by this author Takahiro Maeda More articles by this author Hirohiko Nagata More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...