Ahmed Eraky, Kaushik P Kolanukuduru, Brenda Hug, Reuben Ben-David, Kyrollis Attalla, Nikhil Waingankar, Peter Wiklund, Reza Mehrazin, John P Sfakianos
{"title":"低、高、中危非肌浸润性膀胱癌对卡介苗-谷氨酰胺和吉西他滨-多西他赛治疗的差异反应","authors":"Ahmed Eraky, Kaushik P Kolanukuduru, Brenda Hug, Reuben Ben-David, Kyrollis Attalla, Nikhil Waingankar, Peter Wiklund, Reza Mehrazin, John P Sfakianos","doi":"10.1016/j.urolonc.2025.03.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>Sequential intravesical gemcitabine/docetaxel (Gem/Doce) is a potential alternative to bacillus Calmette-Guérin (BCG) for treating non-muscle-invasive bladder cancer (NMIBC). Intermediate-risk NMIBC group (IR-NMIBC) includes both low-grade (LG) and high-grade tumors (HG). This study investigates the response of HG and LG IR-NMIBC to Gem/Doce compared to BCG therapy.</p><p><strong>Methods: </strong>We included patients with IR-NMIBC who received either BCG or Gem/Doce between 2013 and 2023. Maintenance regimens were administered to patients without recurrence after induction for 1 year. Follow-up cystoscopies were performed per American Urological Association (AUA) guidelines. Kaplan-Meier and Cox regression analyses were performed to evaluate recurrence-free survival (RFS) and progression-free survival (PFS).</p><p><strong>Results: </strong>Among 505 NMIBC patients, 150 were IR-NMIBC: 115 with HG tumors (69 received BCG, 46 received Gem/Doce) and 35 with LG tumors (14 received BCG, 21 received Gem/Doce).With a median follow-up time of 31 months (Interquartile Range [IQR] 13-54), The overall 2-year any-grade RFS was 55%. For HG and LG groups, the 2-year any-grade RFS was 58% and 35% (P = 0.009), respectively. High-grade RFS at 2 years was 75% for HG and 94% for LG (P = 0.065). The 2-year PFS was similar between groups, at 96% for both HG and LG (P = 0.39). In HG patients, 2-year high-grade RFS was higher with BCG than Gem/Doce (81% vs. 59%, P = 0.008). In LG patients, 2-year any-grade and high-grade RFS were comparable between BCG and Gem/Doce (P = 0.067 and P = 0.37, respectively).</p><p><strong>Conclusions: </strong>Our findings suggest that BCG may offer a superior benefit in terms of high-grade RFS for HG IR-NMIBC compared to Gem/Doce, while LG tumors respond similarly to both treatments. This emphasizes the role of risk stratification in treatment selection. Prospective studies are needed to validate these findings and refine treatment strategies.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differential response of low- and high-grade intermediate-risk non-muscle-invasive bladder cancer to bacillus Calmette-Guérin and gemcitabine-docetaxel therapy.\",\"authors\":\"Ahmed Eraky, Kaushik P Kolanukuduru, Brenda Hug, Reuben Ben-David, Kyrollis Attalla, Nikhil Waingankar, Peter Wiklund, Reza Mehrazin, John P Sfakianos\",\"doi\":\"10.1016/j.urolonc.2025.03.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objective: </strong>Sequential intravesical gemcitabine/docetaxel (Gem/Doce) is a potential alternative to bacillus Calmette-Guérin (BCG) for treating non-muscle-invasive bladder cancer (NMIBC). Intermediate-risk NMIBC group (IR-NMIBC) includes both low-grade (LG) and high-grade tumors (HG). This study investigates the response of HG and LG IR-NMIBC to Gem/Doce compared to BCG therapy.</p><p><strong>Methods: </strong>We included patients with IR-NMIBC who received either BCG or Gem/Doce between 2013 and 2023. Maintenance regimens were administered to patients without recurrence after induction for 1 year. Follow-up cystoscopies were performed per American Urological Association (AUA) guidelines. Kaplan-Meier and Cox regression analyses were performed to evaluate recurrence-free survival (RFS) and progression-free survival (PFS).</p><p><strong>Results: </strong>Among 505 NMIBC patients, 150 were IR-NMIBC: 115 with HG tumors (69 received BCG, 46 received Gem/Doce) and 35 with LG tumors (14 received BCG, 21 received Gem/Doce).With a median follow-up time of 31 months (Interquartile Range [IQR] 13-54), The overall 2-year any-grade RFS was 55%. For HG and LG groups, the 2-year any-grade RFS was 58% and 35% (P = 0.009), respectively. High-grade RFS at 2 years was 75% for HG and 94% for LG (P = 0.065). The 2-year PFS was similar between groups, at 96% for both HG and LG (P = 0.39). In HG patients, 2-year high-grade RFS was higher with BCG than Gem/Doce (81% vs. 59%, P = 0.008). In LG patients, 2-year any-grade and high-grade RFS were comparable between BCG and Gem/Doce (P = 0.067 and P = 0.37, respectively).</p><p><strong>Conclusions: </strong>Our findings suggest that BCG may offer a superior benefit in terms of high-grade RFS for HG IR-NMIBC compared to Gem/Doce, while LG tumors respond similarly to both treatments. This emphasizes the role of risk stratification in treatment selection. Prospective studies are needed to validate these findings and refine treatment strategies.</p>\",\"PeriodicalId\":23408,\"journal\":{\"name\":\"Urologic Oncology-seminars and Original Investigations\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologic Oncology-seminars and Original Investigations\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urolonc.2025.03.009\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2025.03.009","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Differential response of low- and high-grade intermediate-risk non-muscle-invasive bladder cancer to bacillus Calmette-Guérin and gemcitabine-docetaxel therapy.
Background and objective: Sequential intravesical gemcitabine/docetaxel (Gem/Doce) is a potential alternative to bacillus Calmette-Guérin (BCG) for treating non-muscle-invasive bladder cancer (NMIBC). Intermediate-risk NMIBC group (IR-NMIBC) includes both low-grade (LG) and high-grade tumors (HG). This study investigates the response of HG and LG IR-NMIBC to Gem/Doce compared to BCG therapy.
Methods: We included patients with IR-NMIBC who received either BCG or Gem/Doce between 2013 and 2023. Maintenance regimens were administered to patients without recurrence after induction for 1 year. Follow-up cystoscopies were performed per American Urological Association (AUA) guidelines. Kaplan-Meier and Cox regression analyses were performed to evaluate recurrence-free survival (RFS) and progression-free survival (PFS).
Results: Among 505 NMIBC patients, 150 were IR-NMIBC: 115 with HG tumors (69 received BCG, 46 received Gem/Doce) and 35 with LG tumors (14 received BCG, 21 received Gem/Doce).With a median follow-up time of 31 months (Interquartile Range [IQR] 13-54), The overall 2-year any-grade RFS was 55%. For HG and LG groups, the 2-year any-grade RFS was 58% and 35% (P = 0.009), respectively. High-grade RFS at 2 years was 75% for HG and 94% for LG (P = 0.065). The 2-year PFS was similar between groups, at 96% for both HG and LG (P = 0.39). In HG patients, 2-year high-grade RFS was higher with BCG than Gem/Doce (81% vs. 59%, P = 0.008). In LG patients, 2-year any-grade and high-grade RFS were comparable between BCG and Gem/Doce (P = 0.067 and P = 0.37, respectively).
Conclusions: Our findings suggest that BCG may offer a superior benefit in terms of high-grade RFS for HG IR-NMIBC compared to Gem/Doce, while LG tumors respond similarly to both treatments. This emphasizes the role of risk stratification in treatment selection. Prospective studies are needed to validate these findings and refine treatment strategies.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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