Discontinuance of Bacille Calmette-Guérin Instillation Therapy for Nonmuscle-invasive Bladder Cancer Has Negative Effect on Tumor Recurrence

Toshikazu Takeda, Eiji Kikuchi, Kazuyuki Yuge, Kazuhiro Matsumoto, Akira Miyajima, Ken Nakagawa, Mototsugu Oya

Research output: Contribution to journalArticle

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Abstract

Objectives: To investigate whether the occurrence of side effects or discontinuance of bacille Calmette-Guérin (BCG) therapy because of side effects is associated with its therapeutic efficacy. Methods: We analyzed the data from 145 patients who had had nonmuscle-invasive bladder cancer (Stage pTa, pT1, or pTis) and had undergone an initial course of adjuvant BCG therapy after transurethral resection of bladder tumor from 1996 and 2006 at Keio University Hospital. Side effects were classified as minor and major, and the association between the occurrence of side effects or discontinuance of BCG therapy because of side effects and tumor recurrence or progression was analyzed. Results: Side effects occurred in 106 patients (73.1%) during BCG instillation. Of these 106 patients, 38 had major side effects and 95 had minor; 27 patients had both. BCG therapy was discontinued in 19 patients (13.1%) because of severe hematuria in 2, high fever in 8, and severe lower urinary tract symptoms in 9. Multivariate analyses demonstrated that discontinuance of BCG therapy (P = .018) was an independent predictor for tumor recurrence, in addition to multiplicity (P = .043). However, the occurrence of side effects was not an independent predictor for tumor recurrence (P = .935). Multivariate analyses also demonstrated that neither discontinuance of BCG therapy (P = .308) nor the occurrence of side effects (P = .333) was an independent predictor for tumor progression. Conclusions: Discontinuation of BCG therapy has a significantly deleterious effect on reducing the incidence of tumor recurrence. When major side effects occur, it might be preferable to attempt to mitigate the major side effects to maintain the BCG therapy on schedule.

Original languageEnglish
Pages (from-to)1318-1322
Number of pages5
JournalUrology
Volume73
Issue number6
DOIs
Publication statusPublished - 2009 Jun

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Urinary Bladder Neoplasms
Recurrence
Neoplasms
Therapeutics
Multivariate Analysis
Lower Urinary Tract Symptoms
Hematuria
Appointments and Schedules
Fever
Incidence

ASJC Scopus subject areas

  • Urology

Cite this

Discontinuance of Bacille Calmette-Guérin Instillation Therapy for Nonmuscle-invasive Bladder Cancer Has Negative Effect on Tumor Recurrence. / Takeda, Toshikazu; Kikuchi, Eiji; Yuge, Kazuyuki; Matsumoto, Kazuhiro; Miyajima, Akira; Nakagawa, Ken; Oya, Mototsugu.

In: Urology, Vol. 73, No. 6, 06.2009, p. 1318-1322.

Research output: Contribution to journalArticle

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abstract = "Objectives: To investigate whether the occurrence of side effects or discontinuance of bacille Calmette-Gu{\'e}rin (BCG) therapy because of side effects is associated with its therapeutic efficacy. Methods: We analyzed the data from 145 patients who had had nonmuscle-invasive bladder cancer (Stage pTa, pT1, or pTis) and had undergone an initial course of adjuvant BCG therapy after transurethral resection of bladder tumor from 1996 and 2006 at Keio University Hospital. Side effects were classified as minor and major, and the association between the occurrence of side effects or discontinuance of BCG therapy because of side effects and tumor recurrence or progression was analyzed. Results: Side effects occurred in 106 patients (73.1{\%}) during BCG instillation. Of these 106 patients, 38 had major side effects and 95 had minor; 27 patients had both. BCG therapy was discontinued in 19 patients (13.1{\%}) because of severe hematuria in 2, high fever in 8, and severe lower urinary tract symptoms in 9. Multivariate analyses demonstrated that discontinuance of BCG therapy (P = .018) was an independent predictor for tumor recurrence, in addition to multiplicity (P = .043). However, the occurrence of side effects was not an independent predictor for tumor recurrence (P = .935). Multivariate analyses also demonstrated that neither discontinuance of BCG therapy (P = .308) nor the occurrence of side effects (P = .333) was an independent predictor for tumor progression. Conclusions: Discontinuation of BCG therapy has a significantly deleterious effect on reducing the incidence of tumor recurrence. When major side effects occur, it might be preferable to attempt to mitigate the major side effects to maintain the BCG therapy on schedule.",
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AU - Yuge, Kazuyuki

AU - Matsumoto, Kazuhiro

AU - Miyajima, Akira

AU - Nakagawa, Ken

AU - Oya, Mototsugu

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AB - Objectives: To investigate whether the occurrence of side effects or discontinuance of bacille Calmette-Guérin (BCG) therapy because of side effects is associated with its therapeutic efficacy. Methods: We analyzed the data from 145 patients who had had nonmuscle-invasive bladder cancer (Stage pTa, pT1, or pTis) and had undergone an initial course of adjuvant BCG therapy after transurethral resection of bladder tumor from 1996 and 2006 at Keio University Hospital. Side effects were classified as minor and major, and the association between the occurrence of side effects or discontinuance of BCG therapy because of side effects and tumor recurrence or progression was analyzed. Results: Side effects occurred in 106 patients (73.1%) during BCG instillation. Of these 106 patients, 38 had major side effects and 95 had minor; 27 patients had both. BCG therapy was discontinued in 19 patients (13.1%) because of severe hematuria in 2, high fever in 8, and severe lower urinary tract symptoms in 9. Multivariate analyses demonstrated that discontinuance of BCG therapy (P = .018) was an independent predictor for tumor recurrence, in addition to multiplicity (P = .043). However, the occurrence of side effects was not an independent predictor for tumor recurrence (P = .935). Multivariate analyses also demonstrated that neither discontinuance of BCG therapy (P = .308) nor the occurrence of side effects (P = .333) was an independent predictor for tumor progression. Conclusions: Discontinuation of BCG therapy has a significantly deleterious effect on reducing the incidence of tumor recurrence. When major side effects occur, it might be preferable to attempt to mitigate the major side effects to maintain the BCG therapy on schedule.

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