José Daniel Subiela, Wojciech Krajewski, Daniel A González-Padilla, Jan Laszkiewicz, Javier Taborda, Júlia Aumatell, Miguel Sanchez Encinas, Giuseppe Basile, Marco Moschini, Jorge Caño-Velasco, Enrique Lopez Perez, Pedro Del Olmo Durán, Andrea Gallioli, Andrzej Tukiendorf, David D'Andrea, Jeremy Yuen-Chun Teoh, Alejandra Serna Céspedes, Renate Pichler, Luca Afferi, Francesco Del Giudice, Juan Gomez Rivas, Simone Albisinni, Francesco Soria, Guillaume Ploussard, Laura S Mertens, Paweł Rajwa, Ekaterina Laukhtina, Benjamin Pradere, Karl Tully, Félix Guerrero-Ramos, Óscar Rodríguez-Faba, Mario Alvarez-Maestro, Jose Luis Dominguez-Escrig, Tomasz Szydełko, Victoria Gomez Dos Santos, Miguel Ángel Jiménez Cidre, Francisco Javier Burgos Revilla
{"title":"挖掘充分的卡介苗-Guérin免疫疗法在极高风险非肌层浸润性膀胱癌中的潜力：肿瘤学结果和风险动态的多中心分析。","authors":"José Daniel Subiela, Wojciech Krajewski, Daniel A González-Padilla, Jan Laszkiewicz, Javier Taborda, Júlia Aumatell, Miguel Sanchez Encinas, Giuseppe Basile, Marco Moschini, Jorge Caño-Velasco, Enrique Lopez Perez, Pedro Del Olmo Durán, Andrea Gallioli, Andrzej Tukiendorf, David D'Andrea, Jeremy Yuen-Chun Teoh, Alejandra Serna Céspedes, Renate Pichler, Luca Afferi, Francesco Del Giudice, Juan Gomez Rivas, Simone Albisinni, Francesco Soria, Guillaume Ploussard, Laura S Mertens, Paweł Rajwa, Ekaterina Laukhtina, Benjamin Pradere, Karl Tully, Félix Guerrero-Ramos, Óscar Rodríguez-Faba, Mario Alvarez-Maestro, Jose Luis Dominguez-Escrig, Tomasz Szydełko, Victoria Gomez Dos Santos, Miguel Ángel Jiménez Cidre, Francisco Javier Burgos Revilla","doi":"10.1016/j.euo.2024.01.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial.</p><p><strong>Objective: </strong>To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG.</p><p><strong>Design, setting, and participants: </strong>A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted.</p><p><strong>Outcome measurements and statistical analysis: </strong>A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes.</p><p><strong>Results and limitation: </strong>A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2).</p><p><strong>Conclusions: </strong>Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy.</p><p><strong>Patient summary: </strong>Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":"1367-1375"},"PeriodicalIF":8.3000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unlocking the Potential of Adequate Bacillus Calmette-Guérin Immunotherapy in Very-high-risk Non-muscle-invasive Bladder Carcinoma: A Multicenter Analysis of Oncological Outcomes and Risk Dynamics.\",\"authors\":\"José Daniel Subiela, Wojciech Krajewski, Daniel A González-Padilla, Jan Laszkiewicz, Javier Taborda, Júlia Aumatell, Miguel Sanchez Encinas, Giuseppe Basile, Marco Moschini, Jorge Caño-Velasco, Enrique Lopez Perez, Pedro Del Olmo Durán, Andrea Gallioli, Andrzej Tukiendorf, David D'Andrea, Jeremy Yuen-Chun Teoh, Alejandra Serna Céspedes, Renate Pichler, Luca Afferi, Francesco Del Giudice, Juan Gomez Rivas, Simone Albisinni, Francesco Soria, Guillaume Ploussard, Laura S Mertens, Paweł Rajwa, Ekaterina Laukhtina, Benjamin Pradere, Karl Tully, Félix Guerrero-Ramos, Óscar Rodríguez-Faba, Mario Alvarez-Maestro, Jose Luis Dominguez-Escrig, Tomasz Szydełko, Victoria Gomez Dos Santos, Miguel Ángel Jiménez Cidre, Francisco Javier Burgos Revilla\",\"doi\":\"10.1016/j.euo.2024.01.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial.</p><p><strong>Objective: </strong>To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG.</p><p><strong>Design, setting, and participants: </strong>A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted.</p><p><strong>Outcome measurements and statistical analysis: </strong>A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes.</p><p><strong>Results and limitation: </strong>A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2).</p><p><strong>Conclusions: </strong>Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy.</p><p><strong>Patient summary: </strong>Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.</p>\",\"PeriodicalId\":12256,\"journal\":{\"name\":\"European urology oncology\",\"volume\":\" \",\"pages\":\"1367-1375\"},\"PeriodicalIF\":8.3000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European urology oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.euo.2024.01.017\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European urology oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.euo.2024.01.017","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Unlocking the Potential of Adequate Bacillus Calmette-Guérin Immunotherapy in Very-high-risk Non-muscle-invasive Bladder Carcinoma: A Multicenter Analysis of Oncological Outcomes and Risk Dynamics.
Background: The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial.
Objective: To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG.
Design, setting, and participants: A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted.
Outcome measurements and statistical analysis: A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes.
Results and limitation: A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2).
Conclusions: Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy.
Patient summary: Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.
期刊介绍：
Journal Name: European Urology Oncology
Affiliation: Official Journal of the European Association of Urology
Focus:
First official publication of the EAU fully devoted to the study of genitourinary malignancies
Aims to deliver high-quality research
Content:
Includes original articles, opinion piece editorials, and invited reviews
Covers clinical, basic, and translational research
Publication Frequency: Six times a year in electronic format
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
