Radical cystectomy for BCG failure: has the timing improved in recent years?
OBJECTIVE
• To analyse if there is a trend in recent years towards performing radical cystectomy (RC) before muscle invasion or extravesical spread after failure of bacille Calmette-Guérin (BCG) for high grade Ta/T1 bladder cancer. Although BCG is indicated for prophylaxis after endoscopic tumour resection there is still a risk of progression.


METHODS
• A retrospective analysis of our RC database (1992-2008) was performed to identify patients who underwent RC after receiving BCG. • Relevant clinical and pathological data for the patients with clinical stage Ta, T1 and/or Tis at initial transurethral resection of bladder tumour were analysed. • Pathological stage and survival for patients undergoing RC from 2003 to 2007 (group 2) were compared with those for patients operated between 1992 and 2002 (group 1).


RESULTS
• A total of 152 patients were included (75 in group 2 and 77 in group 1). Both groups were similar in T-stage before BCG initiation, number of BCG cycles received and time interval to RC. • There was no change in the proportion of patients undergoing RC with ≥ pT2 bladder cancer in recent years (P= 0.5). • Fifty-two percent of group 2 and 43% of group 1 had ≥ pT2 BC. The 5-year survival was similar.


CONCLUSIONS
• Despite concerns about delay in performing RC for patients failing one or more courses of BCG we have not observed a trend towards a lower pathological stage for patients undergoing RC after BCG. • A high proportion of patients have muscle-invasive bladder cancer; more than 10% have lymph node metastasis.
Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA. msoloway@med.miami.edu
Mark S
MS
Soloway
David
D
Hepps
Devendar
D
Katkoori
Rajinikanth
R
Ayyathurai
Murugesan
M
Manoharan
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
D000970:Antineoplastic Agents; D001500:BCG Vaccine