Is intravesical Bacillus Calmette-Guérin therapy superior to chemotherapy for intermediate-risk non-muscle-invasive bladder cancer? An ongoing debate.
The objective of this study was to evaluate the risk of recurrence in patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) after intravesical instillation with chemotherapeutic agents or Bacillus Calmette-Guérin (BCG) therapy. A cohort of 746 patients with intermediate-risk NMIBC comprised the study group. The primary outcome was time to first recurrence. The recurrence rates of the transurethral resection (TUR) alone, chemotherapy, and BCG groups were determined using Kaplan-Meier analysis. Risk factors for recurrence were identified using Cox regression analysis. In total, 507 patients (68.1%), 78 patients (10.5%), and 160 (21.4%) underwent TUR, TUR+BCG, or TUR+chemotherapy, respectively. After a median follow-up period of 51.7 months (interquartile range=33.1-77.8 months), 286 patients (38.5%) developed tumor recurrence. The 5-yr recurrence rates for the TUR, chemotherapy, and BCG groups were 53.6%±2.7%, 30.8%±5.7%, and 33.6%±4.7%, respectively (P<0.001). Chemotherapy and BCG treatment were found to be predictors of reduced recurrence. Cox-regression analysis showed that TUR+BCG did not differ from TUR+chemotherapy in terms of recurrence risk. Adjuvant intravesical instillation is an effective prophylactic that prevents tumor recurrence in intermediate-risk NMIBC patients following TUR. In addition, both chemotherapeutic agents and BCG demonstrate comparable efficacies for preventing recurrence.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kyung-Sik
0000-0003-4924-9627
KS
Han
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Dalsan
0000-0001-8152-847X
D
You
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
In Gab
0000-0003-4093-832X
IG
Jeong
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Teakmin
0000-0003-2280-319X
T
Kwon
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Bumsik
0000-0003-1991-1229
B
Hong
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jun Hyuk
0000-0003-2705-0481
JH
Hong
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hanjong
0000-0001-7608-5352
H
Ahn
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Tai Young
0000-0003-4432-0340
TY
Ahn
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Choung-Soo
0000-0002-7464-3207
CS
Kim
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D012306:Risk; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D001500:BCG Vaccine
BCG Vaccine; Chemotherapy; Transurethral Resection; Urinary Bladder Neoplasm