Outcomes in BCG failure: Outcome from a single centre UK experience

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass Pub Date : 2025-05-06 DOI:10.1002/bco2.70025

Elizabeth Day, Rachel Aquilina, Lazaros Tzelves, Ashwin Sridhar, Anthony Ta, John Kelly, Bernadett Szabados

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Abstract

Objective

To describe real-world outcomes of patients with BCG failure undergoing bladder-sparing treatments (BSTs) vs radical cystectomy in the UK.

Patients and Methods

A single institution audit was conducted at a tertiary bladder cancer referral service (UCLH, London, UK). Patients with BCG failure treated between January 2017 and September 2022 were included. BSTs included endoscopic surveillance, hyperthermic mitomycin and further BCG. The primary outcome was event free survival (EFS). Complete response (CR) rate and duration of response (DoR) were investigated in patients undergoing BST. The secondary outcomes were 3- and 5-year cancer-specific (CSS) and overall survival (OS).

Results

A total of 112 patients were included: 30% (34/112), 32% (36/112) and 27% (30/112) had BCG unresponsive, exposed and intolerant disease and 11% (12/112) had progressed to muscle invasive disease (MIBC).

In the BCG unresponsive and exposed groups, 79% (27/34) and 72% (26/36) underwent RC, with the remaining receiving BSTs. Comparing RC vs BST in BCG unresponsive and exposed groups combined, there was a significantly poorer EFS in the BST group (p < 0.001); 35.3% (6/17) patients transitioned to second-line BST due to recurrence or intolerance and a further 50% (3/6) transitioned a third line BST. There was no significant difference in CSS or OS rates. In BCG intolerance, the EFS rate was 90% as three patients experienced high-grade recurrence and underwent RC. There were no cancer-related deaths. In MIBC group, 5/12 presented with metastatic disease and 3- and 5-year CSS rates was 66% and 0%.

Conclusion

This data reports real-world practice in a UK centre. BSTs in BCG unresponsive and exposed disease are supported as an alternative to RC providing the increased risk of recurrence is accepted. Additionally, consideration of formal guidance supporting BST is needed in BCG intolerance, which appears to have an excellent outcome in a cohort managed with endoscopic surveillance. Upstaging to MIBC remains a poor prognostic factor and is key to improving survival outcomes in BCG failure.

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BCG失败的结果：来自英国单一中心经验的结果

目的：比较英国卡介苗失败患者接受膀胱保留治疗（BSTs）与根治性膀胱切除术的实际结果。患者和方法对一家第三期膀胱癌转诊中心（UCLH, London， UK）进行了单机构审计。纳入了2017年1月至2022年9月期间接受卡介苗治疗失败的患者。BSTs包括内窥镜监测，热丝裂霉素和进一步卡介苗。主要终点为无事件生存期（EFS）。观察BST患者的完全缓解率（CR）和缓解持续时间（DoR）。次要结局为3年和5年癌症特异性（CSS）和总生存期（OS）。结果共纳入112例患者，其中30%（34/112）、32%（36/112）和27%（30/112）为卡介苗无应答、暴露和不耐受疾病，11%（12/112）发展为肌肉侵袭性疾病（MIBC）。在卡介苗无应答组和暴露组中，分别有79%（27/34）和72%（26/36）接受了RC，其余接受了bst。将卡介苗无应答组和暴露组的RC与BST合并比较，BST组的EFS明显较差（p < 0.001）；35.3%（6/17）的患者由于复发或不耐受而过渡到二线BST，另有50%（3/6）的患者过渡到三线BST。CSS和OS率无显著差异。在卡介苗不耐受的患者中，有3名患者经历了高度复发并接受了RC， EFS发生率为90%。没有癌症相关的死亡。在MIBC组中，5/12出现转移性疾病，3年和5年CSS发生率分别为66%和0%。结论：该数据报告了英国中心的实际实践。在卡介苗无应答性和暴露性疾病中，bst被支持作为RC的替代方案，因为复发风险增加是可以接受的。此外，在卡卡苗不耐受患者中，需要考虑支持BST的正式指导，这在内镜监测下的队列中似乎有很好的结果。对MIBC的抢先治疗仍然是一个不良的预后因素，是改善BCG失败患者生存结果的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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