Can we offer additional BCG therapy for three-month BCG refractory high grade/T1, Tis bladder cancer patients?

IF 1.3 Q3 UROLOGY & NEPHROLOGY

Arab Journal of Urology Pub Date : 2023-01-01 DOI:10.1080/2090598X.2023.2190687

Amr A Elsawy, Mahmoud Laymon, Islam Mansour, Ahmed Elghareeb, Ahmed Harraz

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Abstract

Background: We lack tools to predict treatment and survival outcomes in patients receiving additional BCG therapy as a bladder-preserving therapy in high grade/T1, Tis NMIBC patients who showed persistent/recurrent tumors at three-month follow-up.

Objectives: To assess the predictors of additional BCG response in patients who experienced persistent/recurrent tumors at three-month follow-up after BCG induction.

Patients and methods: We retrospectively analyzed database for NMIBC. Between 2000 and 2019, 231 patients with high-grade T1/Tis NMIBC showed persistent/recurrent tumors at 3-month after BCG-induction, refused or were unfit to radical cystectomy (RC) and were offered additional intravesical BCG as bladder-preserving treatment. Predictors of the outcome after additional BCG were studied using univariate and multivariate logistic regression analysis. Kaplan Meier curve was utilized to estimate the recurrence-free survival (RFS) and progression-free survival (PFS). COX regression analysis was performed to identify independent predictors or RFS and PFS.

Results: During a median (range) of 148 (24-224) months, poor response to additional BCG (tumor recurrence and/or progression) was noted in 112 (48.5%) patients. On multivariate logistic regression analysis, 3-month tumor features (persistent T stage, persistent grade and persistent/new CIS) significantly predicted poor response to additional BCG (OR: 3.4, 95%CI: 1.3-10.8, p = 0.021, OR: 2.1, 95%CI: 1.1-4.1, p = 0.02 and OR: 16.6, 95%CI: 4.5-109, p=<0.001, respectively). The mean RFS was 26 (9-152) months with identified 3-month tumor features (persistent T stage and persistent/new CIS) as independent predictors of RFS (HR = 11.5, 95%CI = 2.7-48.3, p = 0.001 and HR = 2.5, 95%CI = 1.5-4.1, p=<0.001, respectively) on multivariate COX regression analysis. In addition, 3-month tumor features (persistent/new CIS, non-papillary shape and bladder neck involvement) were identified to significantly predict PFS (HR = 6.2, 95%CI = 3.4-11.5, p=<0.001 and HR = 2.3, 95%CI = 1.3-4.3 p = 0.001 and HR = 2.1, 95%CI = 1.2-3.8, p=<0.005, respectively).

Conclusions: Three-month tumor features could be utilized as a tool to predict treatment outcomes and survival benefits when additional intravesical BCG is utilized as a bladder-preserving treatment in patients with recurrent/persistent tumors at three-month follow-up.

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我们能否为三个月的卡介苗难治性高分级/T1、Tis膀胱癌患者提供额外的卡介苗治疗?

背景:我们缺乏工具来预测接受额外卡介苗治疗作为保膀胱治疗的高级别/T1, Tis NMIBC患者的治疗和生存结果，这些患者在三个月的随访中表现出持续性/复发性肿瘤。目的:评估卡介苗诱导后持续/复发肿瘤患者3个月随访时卡介苗应答的预测因素。患者和方法:回顾性分析NMIBC数据库。在2000年至2019年期间，231例高级别T1/Tis NMIBC患者在BCG诱导后3个月出现持续性/复发性肿瘤，拒绝或不适合根治性膀胱切除术(RC)，并给予额外的膀胱内BCG作为保膀胱治疗。采用单因素和多因素logistic回归分析研究附加BCG后预后的预测因素。采用Kaplan Meier曲线估计无复发生存期(RFS)和无进展生存期(PFS)。采用COX回归分析确定RFS和PFS的独立预测因子。结果:在148(24-224)个月的中位(范围)期间，112(48.5%)例患者对额外的卡介苗(肿瘤复发和/或进展)反应不良。在多因素logistic回归分析中，3个月肿瘤特征(持续T分期、持续分级和持续/新CIS)显著预测额外BCG治疗不良反应(OR: 3.4, 95%CI: 1.3-10.8, p= 0.021, OR: 2.1, 95%CI: 1.1-4.1, p= 0.02和OR: 16.6, 95%CI: 4.5-109, p=p=p=p= p=p=p=p=)。3个月肿瘤特征可以作为预测治疗结果和生存获益的工具，当在3个月的随访中对复发/持续性肿瘤患者使用额外的膀胱内卡介苗作为保膀胱治疗时。

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来源期刊

Arab Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

2.80

自引率

0.00%

发文量

期刊介绍： The Arab Journal of Urology is a peer-reviewed journal that strives to provide a high standard of research and clinical material to the widest possible urological community worldwide. The journal encompasses all aspects of urology including: urological oncology, urological reconstructive surgery, urodynamics, female urology, pediatric urology, endourology, transplantation, erectile dysfunction, and urinary infections and inflammations. The journal provides reviews, original articles, editorials, surgical techniques, cases reports and correspondence. Urologists, oncologists, pathologists, radiologists and scientists are invited to submit their contributions to make the Arab Journal of Urology a viable international forum for the practical, timely and state-of-the-art clinical urology and basic urological research.