title: The Timing of Radical Cystectomy for bacillus Calmette-Guérin Failure: Comparison of Outcomes and Risk Factors for Prognosis.
abstract: We compared the pathological and survival outcomes of patients who underwent radical cystectomy soon after bacillus Calmette-Guérin failure with those of patients who received additional salvage intravesical chemotherapy before cystectomy for nonmuscle invasive bladder cancer. We also identified predictors of prognosis in the entire cohort.
  
  
  
  We retrospectively analyzed the records of 117 patients who underwent radical cystectomy for recurrent nonmuscle invasive bladder cancer at our institution from 1990 to 2012. The cohort was divided into group 1 of 61 patients treated only with bacillus Calmette-Guérin with or without interferon-α and group 2 of 56 who received at least 1 additional salvage intravesical chemotherapy after bacillus Calmette-Guérin.
  
  
  
  Final pathology and survival outcomes did not differ significantly between the groups. Five-year overall and cancer specific survival was similar in groups 1 and 2 at 80% and 85%, respectively, at approximately equivalent followups. Median bladder retention was 1.7 years longer in group 2 (p <0.001). On multivariate Cox regression analysis delayed cystectomy in group 2 did not convey a significant hazard for all cause mortality after cystectomy (HR 1.08, p = 0.808). Only up-staging to cT1 (HR 1.88, p = 0.045), lymph node invasion (HR 2.58, p = 0.023) and prostatic urethra involvement (HR 1.95, p = 0.029) achieved significance.
  
  
  
  With appropriate selection for salvage intravesical chemotherapy patients who elect bladder sparing treatment instead of earlier radical cystectomy after bacillus Calmette-Guérin fails do not sacrifice positive pathological or oncologic outcomes while retaining bladder function for a significantly longer duration.
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: crh2109@cumc.columbia.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Haas
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: LaMont J
authors.initials: LJ
authors.lastname: Barlow
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Badalato
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: G Joel
authors.initials: GJ
authors.lastname: DeCastro
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.affiliation: Herbert Irving Cancer Center and Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D016898:Interferon-alpha
keywords: BCG vaccine; cystectomy; mortality; treatment failure; urinary bladder neoplasms