title: Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer.
abstract: BACKGROUND
  Patients with high-risk non-muscle invasive bladder cancer (NMIBC) need adjuvant intravesical treatment after surgery. Although bacillus Calmette-Guérin (BCG) is highly effective, new adjuvant treatments to decrease recurrences and toxicity have been studies. We performed a retrospective propensity score-matched study to compare the efficacy of BCG and chemohyperthermia (C-HT).
  
  
  METHODS
  We included 1937 patients diagnosed with bladder cancer between January 2004 and January 2014. The primary efficacy endpoint was recurrence-free interval. Patients treated with C-HT were matched with patients treated with BCG using propensity score-matched analysis. Cox-regression models were used to estimate the association between intravesical treatments and the presence of recurrence and progression.
  
  
  RESULTS
  Of the 710 patients treated with intravesical treatments, 40 and 142 were eligible for inclusion in C-HT and BCG groups, respectively. Following case matching, there were no differences in patient or tumour characteristics between treatment groups. The 2-year recurrence-free interval in C-HT and BCG groups were 76.2% and 93.9%, respectively (p = 0.020). C-HT treatment (hazard ratio [HR] 5.42; 95% confidence interval [CI] 1.11-26.43; p = 0.036) and high-grade tumour (HR 4.60; 95% CI 1.01-20.88; p = 0.048) are associated with an elevated odds of tumour recurrence. In multivariate Cox-regression analysis, there was no significant difference between C-HT and BCG in the odds of recurrence (p = 0.054). There were no differences in progression between C-HT and BCG.
  
  
  CONCLUSIONS
  C-HT is not as effective treatment as BCG in high-risk NMIBC patients who are BCG-naive. Although, there were no significant difference in the odds of recurrence, recurrence-free interval is significantly improved by the administration of BCG.
authors.affiliation: Tepecik Teaching and Research Hospital, Department of Urology, Turkey;
authors.forename: Rahmi Gokhan
authors.initials: RG
authors.lastname: Ekin
authors.affiliation: Kemalpasa State Hospital, Urology Clinic, Turkey;
authors.forename: Ilker
authors.initials: I
authors.lastname: Akarken
authors.affiliation: Tepecik Teaching and Research Hospital, Department of Urology, Turkey;
authors.forename: Ferruh
authors.initials: F
authors.lastname: Zorlu
authors.affiliation: Tepecik Teaching and Research Hospital, Department of Urology, Turkey;
authors.forename: Huseyin
authors.initials: H
authors.lastname: Tarhan
authors.affiliation: Tepecik Teaching and Research Hospital, Department of Pathology, Turkey;
authors.forename: Ulku
authors.initials: U
authors.lastname: Kucuk
authors.affiliation: Tepecik Teaching and Research Hospital, Department of Pathology, Turkey;
authors.forename: Zubeyde
authors.initials: Z
authors.lastname: Yildirim
authors.affiliation: Department of Urology, Sifa University, Faculty of Medicine, Izmir, Turkey.
authors.forename: Rauf Taner
authors.initials: RT
authors.lastname: Divrik