Radical cystectomy for BCG failure: has the timing improved in recent years?

Authors


Mark S. Soloway, Professor and Chairman Department of Urology, University of Miami Miller School of Medicine, P.O. Box 016960 (M814), Miami, Fl 33101, USA.
e-mail: msoloway@med.miami.edu

Abstract

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.

OBJECTIVE

  • • 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).

RESULTS

  • • 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.

CONCLUSIONS

  • • 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.

Ancillary