title: Construction of predictive models for cancer-specific survival of patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: results from a multicenter retrospective study.
abstract: OBJECTIVE
  The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guérin failure classification advocated by Nieder et al. in patients with non-muscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guérin therapy.
  
  
  METHODS
  Data from 402 patients who received intravesical bacillus Calmette-Guérin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guérin failure were analyzed for this study.
  
  
  RESULTS
  Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guérin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guérin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the follow-up. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (≥70 [P = 0.002]), tumor size (≥3 cm [P = 0.015]) and the Nieder classification (bacillus Calmette-Guérin refractory [P < 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Patients with stage progression at the first recurrence after bacillus Calmette-Guérin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin into three risk groups based on the number of prognostic factors in each one.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo nishiyan@sapmed.ac.jp.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Asahikawa Red Cross Hospital, Asahikawa.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hotta
authors.affiliation: Department of Urology, Hakodate Goryoukaku Hospital, Hakodate.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Urology, Sunagawa City Medical Center, Sunagawa.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Urology, NTT East Japan Sapporo Hospital, Sapporo.
authors.forename: Naoki
authors.initials: N
authors.lastname: Itoh
authors.affiliation: Department of Urology, Steel Memorial Muroran Hospital, Muroran.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tachiki
authors.affiliation: Department of Urology, Muroran City General Hospital, Muroran.
authors.forename: Noriomi
authors.initials: N
authors.lastname: Miyao
authors.affiliation: Department of Urology, Takikawa Municipal Hospital, Takikawa.
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsukawa
authors.affiliation: Department of Urology, Hokkaido Social Work Association Obihiro Hospital, Obihiro.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kunishima
authors.affiliation: Department of Urology, Oji General Hospital, Tomakomai, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Taguchi
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo.
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
mesh_terms: D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage*; D015653:Cystectomy; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery
chemical_list: D001500:BCG Vaccine
keywords: BCG failure classification; bacillus Calmette-Guérin; non-muscle-invasive bladder cancer