title: Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy.
abstract: OBJECTIVE
  To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG.
  
  
  METHODS
  We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks.
  
  
  RESULTS
  The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003).
  
  
  CONCLUSIONS
  In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.
authors.affiliation: Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: jpalou@fundacio-puigvert.es.
authors.forename: J
authors.initials: J
authors.lastname: Palou-Redorta
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Instituto Valenciano de Oncología, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Solsona
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Angulo
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Hospital Central de Asturias, Universidad de Oviedo, Oviedo, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Departamento de Estadística, Hospital la Paz, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Madero
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Hospital de Basurto, Bilbao, España.
authors.forename: M
authors.initials: M
authors.lastname: Unda
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Hospital La Paz, Madrid, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez-Piñeiro
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Hospital Marqués de Valdecilla, Santander, España.
authors.forename: J
authors.initials: J
authors.lastname: Portillo
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
authors.forename: V
authors.initials: V
authors.lastname: Chantada
authors.affiliation: Club Urológico Español de Tratamiento Oncológico (CUETO); Servicio de Urología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Moyano
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: Bacille Calmette-Guérin; Bacilo de Calmette-Guérin; Maintenance therapy; Nonmuscle-invasive bladder tumour; Resección transuretral de tumor vesical; T1G3 carcinoma urotelial; T1G3 urothelial carcinoma; Transurethral resection of bladder tumour; Tratamiento de mantenimiento; Tumor vesical no músculo-invasivo