Can we offer additional BCG therapy for three-month BCG refractory high grade/T1, Tis bladder cancer patients?

• Published in: Arab Journal of Urology 2023-07, Vol.21 (3), p.142-149
• Main Authors: Elsawy, Amr A., Laymon, Mahmoud, Mansour, Islam, Elghareeb, Ahmed, Harraz, Ahmed
• Format: Article
• Language: English
• Subjects: BCG refractory; Bladder cancer; Oncology/Reconstruction; progression; recurrence; three-month cystoscopy
• ISSN: 2090-598X; 2090-598X; 2090-5998
• DOI: 10.1080/2090598X.2023.2190687

We lack tools to predict treatment and survival outcomes in patients receiving additional BCG therapy as a bladder-preserving therapy in high grade/T1, Tis NMIBC patients who showed persistent/recurrent tumors at three-month follow-up. To assess the predictors of additional BCG response in patients who experienced persistent/recurrent tumors at three-month follow-up after BCG induction. We retrospectively analyzed database for NMIBC. Between 2000 and 2019, 231 patients with high-grade T1/Tis NMIBC showed persistent/recurrent tumors at 3-month after BCG-induction, refused or were unfit to radical cystectomy (RC) and were offered additional intravesical BCG as bladder-preserving treatment. Predictors of the outcome after additional BCG were studied using univariate and multivariate logistic regression analysis. Kaplan Meier curve was utilized to estimate the recurrence-free survival (RFS) and progression-free survival (PFS). COX regression analysis was performed to identify independent predictors or RFS and PFS. During a median (range) of 148 (24-224) months, poor response to additional BCG (tumor recurrence and/or progression) was noted in 112 (48.5%) patients. On multivariate logistic regression analysis, 3-month tumor features (persistent T stage, persistent grade and persistent/new CIS) significantly predicted poor response to additional BCG (OR: 3.4, 95%CI: 1.3-10.8, p = 0.021, OR: 2.1, 95%CI: 1.1-4.1, p = 0.02 and OR: 16.6, 95%CI: 4.5-109, p=