title: [Muscularis mucosae invasion: prognostic factor for intravesical BCG immunotherapy failure for T1 bladder carcinoma].
abstract: OBJECTIVE
  To study the prognostic impact of muscularis mucosae (MM) invasion for pT1 bladder cancer treated by transurethral resection (TUR) and adjuvant Bacille Calmette-Guerin (BCG) intravesical immunotherapy.
  
  
  METHODS
  Sixty-six patients treated by BCG intravesical instillations were substaged into pT1a and pT1b, regarding Muscularis Mucosae invasion. Tumor grade, associated carcinoma in situ (CIS), multifocality, tumoral size up to 3cm, BCG maintenance were noted. With a mean follow-up of 50.5±38 months, we studied recurrence, progression, overall and specific survival. Cox's model method was used for multivariate analysis.
  
  
  RESULTS
  Tumor recurrence was observed in 30±7% and 43±10% (P=0.29) and tumor progression in 16.3±5% and 39±10% (P=0.04) for pT1a and pT1b. The rate of progression was higher (P=0.04) and progression free survival was decreased (P=0.04) for pT1b. Specific death rates were 11±5% and 21±9% (P=0.28), median overall survival was 80.9 [1.5-92] and 48.2 [12-93] months for pT1a and pT1b. Overall and specific survival weren't different between the two populations (P=0.38; P=0.3). Cystectomy rates were 2.3±2% and 30±9% for pT1a and PT1b (P=0.0006). For pT1a patients, recurrence (P=0.8) or progression rates (P=0.64) were no different regarding BCG maintenance immunotherapy but pT1b population had a better progression free survival with BCG maintenance than without (P=0.0051). Only CIS had prognostic value in multivariate analysis.
  
  
  CONCLUSIONS
  Tumors with Muscularis Mucosae invasion have a higher risk of progression and BCG failure. Maintenance immunotherapy should be given to improve results with these patients.
authors.affiliation: Service d'urologie et de transplantation rénale, hôpital Saint-Jacques, CHU de Besançon, 2, place Saint-Jacques, 25030 Besançon cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Nguyen-Huu
authors.forename: G
authors.initials: G
authors.lastname: Delorme
authors.forename: J
authors.initials: J
authors.lastname: Lillaz
authors.forename: I
authors.initials: I
authors.lastname: Bedgedjian
authors.forename: I
authors.initials: I
authors.lastname: Le Ray-Ferrières
authors.forename: E
authors.initials: E
authors.lastname: Chabannes
authors.forename: S
authors.initials: S
authors.lastname: Bernardini
authors.forename: G
authors.initials: G
authors.lastname: Guichard
authors.forename: H
authors.initials: H
authors.lastname: Bittard
authors.forename: F
authors.initials: F
authors.lastname: Kleinclauss
mesh_terms: D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D015653:Cystectomy; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology*; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
chemical_list: D001500:BCG Vaccine