Construction of Predictive Models for Cancer-specific Survival of Patients with Non-muscle-invasive Bladder Cancer Treated with Bacillus Calmette-Guerin: Results from a Multicenter Retrospective Study

Objective: The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guerin failure classification advocated by Nieder et al. in patients with non-muscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guerin therapy. Methods: Data from 402 patients who received intravesical bacillus Calmette-Guerin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guerin failure were analyzed for this study. Results: Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guerin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guerin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the follow-up. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (>= 70 [P = 0.002]), tumor size (>= 3 cm [P = 0.015]) and the Nieder classification (bacillus Calmette-Guerin refractory [P < 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P < 0.001). Conclusions: Patients with stage progression at the first recurrence after bacillus Calmette-Guerin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guerin into three risk groups based on the number of prognostic factors in each one.