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Outcomes of BCG vs upfront radical cystectomy for high-risk non-muscle-invasive bladder cancer
P. Scilipoti, M. Longoni, M. de Angelis, P. Zaurito, A. Ślusarczyk, F. Soria, B. Pradere, W. Krajewski, D. D'Andrea, A. Mari, F. Del Giudice, R. Pichler, JD. Subiela, G. Marcq, A. Gallioli, L. Afferi, R. Mastroianni, G. Simone, S. Albisinni, LS....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, multicentrická studie, srovnávací studie
PubMed
39967051
DOI
10.1111/bju.16675
Knihovny.cz E-zdroje
- MeSH
- adjuvancia imunologická * terapeutické užití MeSH
- BCG vakcína * terapeutické užití MeSH
- cystektomie * metody MeSH
- invazivní růst nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory močového měchýře neinvadující svalovinu MeSH
- nádory močového měchýře * patologie mortalita chirurgie terapie farmakoterapie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
OBJECTIVE: To assess the oncological outcomes of patients with high-risk (HR) and very high-risk (VHR) non-muscle-invasive bladder cancer (NMIBC) treated with upfront radical cystectomy (RC) vs Bacillus Calmette-Guérin (BCG) instillations from a contemporary European multicentre cohort. PATIENTS AND METHODS: We conducted a retrospective analysis of 1491 patients diagnosed with HR- or VHR-NMIBC from a European multicentre database between 2015 and 2024. Patients were included if they received either upfront RC or at least five doses of BCG. A 1:1 propensity score matching (PSM) according to clinically relevant variables was applied. Progression was defined as muscle-invasive or metastatic disease. Cumulative incidence plots and multivariable competing risk regression models addressing cancer-specific mortality (CSM) were fitted. RESULTS: Among the 1221 patients with HR- (n = 1221 [90%]) or VHR-NMIBC (n = 121 [10%]), 87 (7.1%) underwent upfront RC. The median follow-up was 2.6 years. After PSM (87 vs 87 patients), the 5-year CSM rate was similar in patients treated with BCG (13%) vs their upfront RC counterparts (16%) (hazard ratio: 1.77, 95% confidence interval [CI] 0.66-4.73; P = 0.3). Of the 1134 patients who initially received BCG, 73 (6.6%) eventually required delayed RC, with 34 (47%) progressing to muscle-invasive bladder cancer before delayed RC. The 3-year CSM rate was comparable in upfront RC (13%) vs delayed RC (11%) among non-progressing patients (P = 0.3). However, patients who progressed before delayed RC had worse 3-year CSM relative to those who did not (13% vs 31%, hazard ratio: 0.32, 95% CI 0.13-0.83; P = 0.018). CONCLUSION: Within a European cohort of patients with HR- and VHR-NMIBC, upfront RC was rarely performed. Patients treated with BCG did not exhibit a CSM disadvantage relative to their upfront RC counterparts. After matching, long-term CSM was similar between BCG therapy and upfront RC. Delayed RC, led to worse outcomes if performed after progression, but matched upfront RC when performed before progression, underscoring importance of timely surgery.
Department of Experimental Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Milan Italy
Department of General Oncological and Functional Urology Medical University of Warsaw Warsaw Poland
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology and Oncologic Urology Wrocław Medical University Wroclaw Poland
Department of Urology Claude Huriez Hospital CHU Lille Lille France
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
Department of Urology Gregorio Marañón University Hospital Madrid Spain
Department of Urology Hospital Universitario de Cáceres Cáceres Spain
Department of Urology Humanitas Clinical and Research Institute IRCCS Milan Italy
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Medical University of Innsbruck Innsbruck Austria
Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology University of Tor Vergata Rome Italy
Department of Urology UROSUD La Croix Du Sud Hospital Quint Fonsegrives France
Department of Urology Weill Cornell Medical College New York NY USA
IRCCS 'Regina Elena' National Cancer Institute Rome Italy
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Urology GRC 5 Predictive Onco Uro AP HP Pitie Salpetriere Hospital Sorbonne University Paris France
Citace poskytuje Crossref.org
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