Multicenter Retrospective Registry Study on BCG Use in Non-Muscle Invasive Bladder Cancer in Latin America: BLATAM (Bladder Cancer in Latin America) Group.
Gustavo M Villoldo, Matias Ignacio Gonzalez, Alvaro Vidal Faune, Ricardo Castillejos Molina, Fernando Meza Montoya, José Gadu Campos Salcedo, Gonzalo Vitagliano, Hamilton Zampolli, Alcedir Raiser Lima, Ruben Bengio, Juan J Camean, Germán Ándres Alfieri, Guido J P Escalante, Ivan Edgar Bravo Castro, Hernando Rios Pita, Juan Escuder, Francisco Rodriguez Covarrubias, Maria Fernanda Oliveira, Rafael Sanchez-Salas, Gabriel Andrés Favre, Eduardo Guevara, Esteban Arismendi Videla, Guillermo Martinez Delgado, Ignacio Tobia, Roberto F Villalba Bachur, Ana Maria Autran
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Abstract
Objectives: This study, conducted by the Bladder Cancer in Latin America (BLATAM) group, aims to analyze epidemiological and therapeutic data on non-muscle invasive bladder cancer (NMIBC) in Latin American patients. It seeks to identify factors contributing to suboptimal responses to Bacillus Calmette-Guérin (BCG) therapy and assess areas for improvement in regional treatment practices.
Materials and methods: A multicenter retrospective study was carried out in collaboration with reference Urology Departments across Latin America. Data were collected using an electronic Case Report Form (CRF) from 2011 to 2021, capturing demographics, clinical presentation, treatment details, and follow-up of NMIBC patients treated with BCG. Statistical analyses included Kaplan-Meier survival analysis for relapse-free survival (RFS).
Results: Data from 292 patients across five countries were analyzed, with a mean age of 70.3 years and a male prevalence of 74%. Smoking history was reported in 70.6% of patients. The mean time to the first BCG dose was 2.4 months post-TURBT, with 26.7% of patients exceeding the recommended 60-day window for induction initiation. While 84% of patients completed BCG induction, only 45.9% followed the recommended Lamm maintenance schedule. Delays in starting maintenance cycles were observed, with a median delay of over 36 days for the first cycle and 65 days for the second cycle. RFS at 1 year and 5 years for high-risk patients was 87.3% and 53.3%, respectively.
Conclusions: This study highlights critical deviations from recommended NMIBC management protocols in Latin America, including delayed BCG initiation and inconsistencies in maintenance therapy. These findings emphasize the need for standardized treatment protocols and improved adherence to international guidelines, which could enhance NMIBC patient outcomes in the region. Collaborative efforts are essential to develop region-specific strategies, improve data collection, and ultimately provide better care for bladder cancer patients in Latin America.
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