Predictive clinico-pathological factors to identify BCG, unresponsive patients, after re-resection for T1 high grade non-muscle invasive bladder cancer

被引：41

作者：

Ferro, Matteo ^{[1
]}

Barone, Biagio ^{[2
]}

Crocetto, Felice ^{[2
]}

Lucarelli, Giuseppe ^{[3
]}

Busetto, Gian Maria ^{[4
]}

Del Giudice, Francesco ^{[5
]}

Maggi, Martina ^{[5
]}

Crocerossa, Fabio ^{[6
]}

Cantiello, Francesco ^{[6
]}

Damiano, Rocco ^{[6
]}

Borghesi, Marco ^{[7
]}

Bove, Pier Luigi ^{[8
]}

Papalia, Rocco ^{[9
]}

Mari, Andrea ^{[10
]}

Luzzago, Stefano ^{[1
,20
]}

Soria, Francesco ^{[11
]}

Marchioni, Michele ^{[12
]}

La Civita, Evelina ^{[13
]}

Terracciano, Daniela ^{[13
]}

Mistretta, Francesco Alessandro ^{[1
,20
]}

Piccinelli, Mattia ^{[1
]}

Marmiroli, Andrea ^{[1
]}

Russo, Giorgio Ivan ^{[14
]}

Schips, Luigi ^{[12
]}

Hurle, Rodolfo ^{[15
,16
]}

Contieri, Roberto ^{[15
,16
]}

Perdona, Sisto ^{[17
]}

Del Prete, Paola ^{[17
]}

Mirone, Vincenzo ^{[2
]}

Tataru, Octavian Sabin ^{[18
]}

Musi, Gennaro ^{[1
,20
]}

Montanari, Emanuele ^{[19
]}

de Cobelli, Ottavio ^{[1
,20
]}

Vartolomei, Mihai Dorin ^{[18
]}

机构：

[1] European Inst Oncol Milan IRCCS, Div Urol, Milan, Italy

[2] Univ Naples Federico II, Dept Neurosci Reprod Sci & Odontostomatol, Naples, Italy

[3] Univ Bari Aldo Moro, Dept Emergency & Organ Transplantat, Androl & Kidney Transplantat Unit, Urol, Bari, Italy

[4] Univ Foggia, Dept Urol & Organ Transplantat, Foggia, Italy

[5] Sapienza Univ Rome, Dept Urol, Policlin Umberto 1, Rome, Italy

[6] Magna Graecia Univ Catanzaro, Dept Urol, Catanzaro, Italy

[7] Univ Genoa, Dept Surg & Integrated Diagnost Sci, Genoa, Italy

[8] Tor Vergata Univ Rome, Dept Surg, Urol Unit, Rome, Italy

[9] Campus Biomed Univ, Dept Urol, Rome, Italy

[10] Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy

[11] Univ Torino, Dept Surg Sci, Div Urol, Turin, Italy

[12] SS Annunziata Hosp, Dept Med Oral & Biotechnol Sci, Urol Unit, Chieti, Italy

[13] Univ Naples Federico II, Dept Translat Med Sci, Naples, Italy

[14] Univ Catania, Dept Urol, Catania, Italy

[15] Milan IRCCS, Ist Clin Human Ist Ricovero & Cura Carattere Sci, Dept Urol, Milan, Italy

[16] Milan IRCCS, Res Hosp, Milan, Italy

[17] Fdn G Pascale IRCCS, Naples, Italy

[18] George Emil Palade Univ Med & Pharm Sci & Technol, IOSUD, Targu Mures, Romania

[19] Univ Milan, Osped Maggiore Policlin, Fdn IRCCS CaGranda, Dept Urol, Milan, Italy

[20] Univ Milan, Dept Oncol & Hematol Oncol, Milan, Italy

来源：

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS | 2022年 / 40卷 / 11期

关键词：

BCG; re-TURB; Non-muscle invasive bladder cancer; BACILLUS-CALMETTE-GUERIN; TRANSURETHRAL RESECTION; HIGH-RISK; UROTHELIAL CARCINOMA; TUMOR; AGE; PROGRESSION; RECURRENCE; SURVIVAL;

D O I：

10.1016/j.urolonc.2022.05.016

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: Seventy-five percent of bladder cancers are non-muscle invasive. The treatment strategy includes the transurethral resec-tion of bladder tumor (TURB) followed by intravesical immunotherapy with the bacillus of Calmette-Guerin (BCG) or chemotherapy, depending on the grade of bladder tumor. Despite a proper BCG intravesical instillations schedule, up to 40% of patients present a failure within 2 years. The aim of this retrospective study was to investigate the predictive factors in the response to BCG in patients with a high-grade non-muscle invasive bladder cancer diagnosis.Materials and methods: Patients with non-muscle invasive bladder cancer from 13 hospitals and academic institutions were identified and treated, from January 1, 2002, until December 31, 2012, with TURB and a subsequent re-TURB for restaging before receiving BCG. Follow-up was performed with urine cytology and cystoscopy every 3 months for 1 year and, successively every 6 months. Univariate and multivariate Cox regression models addressed the response to BCG therapy. Kaplan-Meier overall survival (OS) and cancer-specific sur-vival (CSS) estimates were determined for BCG responsive vs. BCG unresponsive patients.Results: A total of 1,228 patients with non-muscle invasive bladder cancer were enrolled. Of 257 (20.9%) patients were BCG unrespon-sive. Independent predictive factors for response to BCG were: multifocality (HR: 1.4; 95% CI 1.05-1.86; P = 0.019), lymphovascular invasion (HR: 1.75; 95% CI 1.22-2.49; P = 0.002) and high-grade on re-TURB (HR: 1.39; 95% CI 1.02-1.91; P = 0.037). Overall survival was significantly reduced in BCG-unresponsive patients compared to BCG-responsive patients at 5 years (82.9% vs. 92.4%, P < 0.0001) and at 10 years (44.2% vs. 74.4%, P < 0.0001). Similarly, cancer-specific survival was reduced in BCG-unresponsive patients at 5 years (90.6% vs. 97.3%, P < 0.0001) and at 10 years (72.3% vs. 87.2%, P < 0.0001).Conclusion: Multifocality, lymphovascular invasion, and high-grade on re-TURB were independent predictors for response to BCG treatment. BCG-unresponsive patients reported worse oncological outcomes. (c) 2022 Elsevier Inc. All rights reserved.

引用

页码：490.e13 / 490.e20

页数：8

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