Retrospective study of various conservative treatment options with bacille Calmette-Guerin in bladder urothelial carcinoma T1G3: Maintenance therapy
Por:
Palou-Redorta, J, Solsona, E, Angulo, J, Fernandez, JM, Madero, R, Unda, M, Martinez-Pineiro, JA, Portillo, J, Chantada, V, Moyano, JL
Publicada:
1 jul 2016
Resumen:
Objective: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guerin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG.
Material and methods: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n = 108), re-TURBT (n = 153), induction with 27 mg of BCG (Connaught strain) (n = 87), induction with 81 mg of BCG (n = 489) or induction with 81 mg of BCG + maintenance (n = 202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks.
Results: The mean follow-up was 62 +/- 39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81 mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27 mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003).
Conclusions: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Palou-Redorta, J:
Univ Autonoma Barcelona, Serv Urol, Fundacio Puigvert, E-08193 Barcelona, Spain
Solsona, E:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Inst Valenciano Oncol, Serv Urol, Valencia, Spain
Angulo, J:
Hosp Univ Getafe, Serv Urol, Madrid, Spain
Fernandez, JM:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Univ Oviedo, Hosp Cent Asturias, E-33080 Oviedo, Spain
Madero, R:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Hosp La Paz, Dept Estadist, Madrid, Spain
Unda, M:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Hosp Basurto, Serv Urol, Bilbao, Spain
Martinez-Pineiro, JA:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Hosp La Paz, Serv Urol, Madrid, Spain
Portillo, J:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Hosp Marques Valdecilla, Serv Urol, Santander, Spain
Chantada, V:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Complejo Hosp Univ A Coruna, Serv Urol, La Coruna, Spain
Moyano, JL:
Club Urol Espanol Tratamiento Oncol, Valencia, Spain
Hosp Univ Virgen Macarena, Serv Urol, Seville, Spain
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