Risk of subsequent tumour recurrence and stage progression in bacille Calmette-Guérin relapsing non-muscle-invasive bladder cancer

Kazuhiro Matsumoto, Eiji Kikuchi, Hiroshi Shirakawa, Nozomi Hayakawa, Nobuyuki Tanaka, Akiharu Ninomiya, Akira Miyajima, So Nakamura, Mototsugu Oya

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE • To investigate the risk of subsequent tumour recurrence and stage progression in bacillus Calmette-Guérin (BCG)-relapsing non-muscle-invasive bladder cancer, defined as recurrence after achieving a disease-free status for 6 months. PATIENTS AND METHODS • A total of 183 patients with BCGrelapsing tumours were treated with conservative therapy between 1985 and 2008 at our three institutions. • We analysed the association between their clinicopathological parameters and subsequent tumour recurrence or stage progression. RESULTS • Additional induction courses of BCG or anticancer drug (mitomycin C or epirubicin) instillations were performed in 119 patients and 24 patients, respectively. The remaining 40 patients did not undergo any adjuvant therapy. • Multivariate analysis showed that a relapsing tumour with a pathologically high risk (defined as tumours with G3 and/or pT1 and/or concomitant carcinoma in situ ) was a significant risk factor for subsequent tumour recurrence ( P = 0.002; hazard ratio [ HR ] 2.15). Additional BCG instillation significantly decreased the subsequent tumour recurrence rate ( P < 0.001; HR 0.41). • Multivariate analysis also showed that a relapsing tumour with a pathologically high risk was also significantly associated with stage progression ( P < 0.001; HR 8.05). CONCLUSIONS • An additional course of BCG instillation might be effective in patients with BCG-relapsing tumours with pathologically intermediate risk. • Nevertheless, some patients with high-risk pathological features developed subsequent stage progression. Such patients should be followed up closely and counselled on the need for aggressive therapeutic options, such as radical cystectomy.

Original languageEnglish
Pages (from-to)E508-E513
JournalBJU international
Volume110
Issue number11 B
DOIs
Publication statusPublished - 2012 Dec 1

Keywords

  • BCG failure
  • BCG relapsing
  • Bacille Calmette-Guérin
  • Non-muscle-invasive bladder cancer
  • Stage progression
  • Tumour recurrence

ASJC Scopus subject areas

  • Urology

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