Contemporary outcomes of bladder carcinoma in situ treated with an adequate bacille Calmette-Guerin immunotherapy
Por:
Subiela, JD, Faba, OR, Aumatell, J, Calderon, J, Mercade, A, Balana, J, Esquinas, C, Algaba, F, Breda, A, Palou, J
Publicada:
1 abr 2022
Ahead of Print:
1 ago 2021
Resumen:
Objective To assess whether bacillus Calmette-Guerin (BCG) responsiveness after initiation of an adequate BCG treatment (at least five of six instillations of induction and at least two of three instillations of maintenance) impacts oncological outcomes in patients with carcinoma in situ (CIS) of the bladder treated with BCG immunotherapy. Patients and Methods Data were available for 193 patients with bladder CIS with or without associated cTa/cT1 disease who received an adequate BCG treatment between 2008 and 2015. Bladder biopsies were taken at 6 months and patients were then stratified as either BCG responsive (negative biopsies) or BCG unresponsive (positive biopsies). Inverse probability weighting (IPW)-adjusted Kaplan-Meier and IPW-adjusted Cox regression were performed to compare progression-free survival (PFS), radical cystectomy-free survival (RCFS), overall survival OS, and cancer-specific survival (CSS) in the two groups. Results and Limitations Comparing the BCG-responsive and BCG-unresponsive groups, IPW-adjusted Kaplan-Meier analysis revealed, respectively, a median (interquartile range) of PFS of 9 (5-15) vs 48.5 (28-77) months (P = 0.001), a RCFS of 11 (9-15) vs 49 (24-76) months (P < 0.001), and a CSS of 25 (13-60) vs 109 (78-307) months (P = 0.004). On IPW-adjusted Cox regression analysis, BCG-unresponsive patients had a worse PFS (hazard ratio [HR] 3.40, 95% confidence interval [CI] 1.59-7.27), RCFS (HR 3.52, 95% CI 1.77-7), and CSS (HR 4.42, 95% CI 1.95-10.01). We found no significant differences for OS. Conclusion Using an IPW method we found that lack of response after initiation of an adequate BCG treatment has prognostic implications beyond identification of complete response in patients with CIS. BCG-unresponsive patients, satisfying the novel definition of BCG unresponsive, showed a poor PFS, RCFS, and CSS. In this setting, the patients should be counselled regarding RC as a first option or enrolled in a clinical trial if they refuse RC or are unfit for surgery.
Filiaciones:
Subiela, JD:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Univ Alcala De Henares, Hosp Univ Ramon y Cajal, Dept Urol, Oncol & Funct Bladder Pathol Unit, Madrid, Spain
Faba, OR:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Aumatell, J:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Calderon, J:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Mercade, A:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Balana, J:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Esquinas, C:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Stat Unit, Barcelona, Spain
Algaba, F:
Univ Autonoma Barcelona, Dept Pathol, Dept Surg, Fundacio Puigvert, Barcelona, Spain
Breda, A:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
Palou, J:
Univ Autanoma Barcelona, Dept Urol, Dept Surg, Fundacio Puigvert,Urooncol Unit, Barcelona, Spain
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