title: Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guérin.
abstract: BACKGROUND
  Controversy exists over the most important prognostic factors in T1 high-grade non-muscle-invasive bladder cancer (NMIBC) patients treated with bacillus Calmette-Guérin (BCG).
  
  
  OBJECTIVE
  Evaluate prognostic factors for recurrence, progression, and disease-specific mortality after adjuvant intravesical BCG immunotherapy in patients with T1G3 NMIBC and long-term follow-up.
  
  
  METHODS
  A single-institution retrospective analysis of 146 patients with primary stage T1G3 NMIBC.
  
  
  METHODS
  All patients were treated with complete transurethral resection (TUR) plus multiple bladder biopsies that included the prostatic urethra. No second TUR was done. Patients underwent an induction course of intravesical BCG (Connaught strain, 81mg) without maintenance therapy.
  
  
  METHODS
  The variables analysed for time to recurrence, progression, and death due to bladder cancer (BCa) were gender, age, tumour multiplicity, diameter, aspect, substaging, concomitant carcinoma in situ (CIS), and CIS in the prostatic urethra. Cox regression models were used to assess the univariate and multivariate prognostic importance of these factors and estimate hazard ratios (HRs). Time-to-event distributions were estimated using cumulative incidence functions.
  
  
  CONCLUSIONS
  The median follow-up was 8.7 yr. Sixty-five patients (44.5%) had recurrence, 25 patients (17.1%) had progression, and 18 patients (12.3%) died because of BCa. Female gender and presence of CIS in the prostatic urethra were associated with an increased risk of recurrence (p=0.0003, HR: 2.53), progression (p=0.001, HR: 3.59), and death due to BCa (p=0.004, HR: 3.53).
  
  
  CONCLUSIONS
  In primary T1G3 bladder tumours treated with induction BCG, female gender or having CIS in the prostatic urethra were the only prognostic factors for time to recurrence, progression, and disease-related mortality. It is very important to perform a biopsy of the prostatic urethra in patients with primary high-grade NMIBC as a first step to obtain this prognostic information.
authors.affiliation: Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain. jpalou@fundacio-puigvert.es
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Sylvester
authors.forename: Oscar Rodríguez
authors.initials: OR
authors.lastname: Faba
authors.forename: Rubén
authors.initials: R
authors.lastname: Parada
authors.forename: Juan A
authors.initials: JA
authors.lastname: Peña
authors.forename: Ferran
authors.initials: F
authors.lastname: Algaba
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015653:Cystectomy / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine