评估bcg无反应和bcg暴露的非肌肉浸润性膀胱癌患者保膀胱治疗的肿瘤学结果。

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-07-31 DOI:10.1016/j.urolonc.2025.07.004

Andrea Piccolini M.D. , Roberto Contieri M.D. , Alessandro Uleri M.D. , Stefano Moretto M.D. , Alessio Finocchiaro M.D. , Muhannad Aljoulani M.D. , Pietro Brin M.D. , Stefano Mancon M.D. , Filippo Dagnino M.D. , Ludovica Cella M.D. , Pier Paolo Avolio M.D. , Marco Paciotti M.D. , Vittorio Fasulo M.D., Ph.D. , Alberto Saita M.D. , Paolo Casale M.D. , Nicolò Maria Buffi M.D. , Giovanni Lughezzani M.D. , Massimo Lazzeri M.D., Ph.D. , Rodolfo Hurle M.D.

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引用次数: 0

摘要

背景：一部分非肌性浸润性膀胱癌（NMIBC）患者介于BCG-naïve和bcg无反应之间，因此引入了“bcg暴露”类别。我们评估了接受保膀胱治疗（BST）的bcg无反应和bcg暴露患者的肿瘤预后。方法：本回顾性研究纳入了BCG无反应和BCG暴露的患者，这些患者接受了BCG联合BST或转向不同的膀胱内化疗。排除卡介苗失败后接受早期RC的患者（N = 14）。Kaplan-Meier （KM）曲线估计HG无复发生存期（HG- rfs）和无进展生存期（PFS）。结果：2005年1月至2022年9月接受BCG治疗的541例患者中，102例（19%）符合纳入标准，66例（65%）根据IBCG标准归类为BCG暴露，36例（35%）为BCG无应答。bcg衰竭的中位随访时间为43个月（四分位数范围：21-70）。49例患者在BST后出现第二次hg复发。其中8例进展。两组HG-RFS （P = 0.47）和PFS (P = 0.77) KM曲线差异无统计学意义。BCG暴露组治疗后3年HG-RFS为57% (95% CI: 43%-69%)， BCG无应答组为39% (95% CI: 21%-57%) (HR: 1.24；95% ci: 0.69-2.21, p = 0.47)。结论：我们的分析显示，bcg暴露患者和bcg无反应患者的hg复发率或进展率无显著差异。在卡介苗失败复发时的分期，而不是自最后一次卡介苗治疗后的间隔时间，成为决定后续管理策略的主要因素。有必要通过更大规模的研究进行验证。

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Assessing oncological outcomes of bladder-sparing treatments in patients with BCG-unresponsive and BCG-exposed non-muscle-invasive bladder cancer

Background

A subset of non-muscle invasive bladder cancer (NMIBC) patients falls between BCG-naïve and BCG-unresponsive, leading to the introduction of the ‘BCG-exposed’ category. We assessed oncological outcomes in BCG-unresponsive and BCG-exposed patients undergoing bladder-sparing treatments (BST).

Methods

This retrospective study included BCG-unresponsive and BCG-exposed patients who underwent BST with BCG or a shift to different intravesical chemotherapy. Patients undergoing early RC after BCG failure (N = 14) were excluded. Kaplan-Meier (KM) curves estimated HG recurrence-free survival (HG-RFS) and progression-free survival (PFS).

Results

Among 541 patients treated with BCG from January 2005 to September 2022, 102 (19%) met inclusion criteria: 66 (65%) were classified as BCG-exposed according to IBCG criteria, 36 (35%) as BCG-unresponsive. Median follow-up from BCG-failure was 43 months (Interquartile range: 21–70). Forty-nine patients had a second HG-recurrence after BST. Of these, 8 patients progressed. No difference in KM curves was observed between the 2 groups for HG-RFS (P = 0.47) and PFS (P = 0.77). The 3-year HG-RFS after BCG treatment was 57% (95% CI: 43%–69%) for BCG-exposed and 39% (95% CI: 21%–57%) for BCG-unresponsive (HR: 1.24; 95% CI: 0.69–2.21, P = 0.47).

Conclusion

Our analysis revealed no significant differences in HG-recurrence or progression rates between BCG-exposed and BCG-unresponsive patients. Stage at the time of BCG failure recurrence, rather than the interval since the last BCG treatment, emerged as the primary factor in determining subsequent management strategies. Validation through larger-scale studies is warranted.

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

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.