Study Type – Therapy (case series)
Level of Evidence 4
What’s known on the subject? and What does the study add?
High-grade Ta-T1-carcinoma in situ bladder cancer is a heterogeneous group; long-term studies have shown that intravesical BCG therapy can be inadequate in a substantial percentage. Despite concerns about delay in performing RC for patients failing one or more courses of BCG, in our study we have not observed a trend towards a lower pathological stage for patients undergoing RC after BCG.
- • To analyse if there is a trend in recent years towards performing radical cystectomy (RC) before muscle invasion or extravesical spread after failure of bacille Calmette–Guérin (BCG) for high grade Ta/T1 bladder cancer. Although BCG is indicated for prophylaxis after endoscopic tumour resection there is still a risk of progression.
PATIENTS AND METHODS
- • A retrospective analysis of our RC database (1992–2008) was performed to identify patients who underwent RC after receiving BCG.
- • Relevant clinical and pathological data for the patients with clinical stage Ta, T1 and/or Tis at initial transurethral resection of bladder tumour were analysed.
- • Pathological stage and survival for patients undergoing RC from 2003 to 2007 (group 2) were compared with those for patients operated between 1992 and 2002 (group 1).
- • A total of 152 patients were included (75 in group 2 and 77 in group 1). Both groups were similar in T-stage before BCG initiation, number of BCG cycles received and time interval to RC.
- • There was no change in the proportion of patients undergoing RC with ≥pT2 bladder cancer in recent years (P= 0.5).
- • Fifty-two percent of group 2 and 43% of group 1 had ≥pT2 BC. The 5-year survival was similar.
- • Despite concerns about delay in performing RC for patients failing one or more courses of BCG we have not observed a trend towards a lower pathological stage for patients undergoing RC after BCG.
- • A high proportion of patients have muscle-invasive bladder cancer; more than 10% have lymph node metastasis.