EVALUATION OF RISK FACTORS AFFECTING RECURRENCE AND PROGRESSION AFTER BCG THERAPY IN NON-MUSCLE INVASIVE BLADDER CANCER
Objective: The study was conducted to evaluate the risk factors associated with recurrence and progression in high-risk non muscle-invasive bladder cancer (NMIBC) patients treated with intravesical Bacillus Calmette Guerin (BCG).
Methods: We retrospectively analysed 101 patients who underwent intravesical BCG for high-risk NMIBC from 2006-2015. Multiple factors such as age, sex, smoking status, prior recurrence rate, high-risk group, tumour size and tumour extent were tested as risk factors for recurrence and progression. We also assessed the probabilities of recurrence and progression after BCG therapy using CUETO (Spanish Urological Club for Oncological Treatment) Scoring model.
Results: Total of 93 males (92.1%) and 8 females (7.9%) were enrolled in our study. Over a median follow up of 24 mo, fifteen patients had a recurrence and six patients had progression after BCG therapy. Both univariate and multivariate analysis shows prior recurrence rate and high-grade tumour as a significant factor for tumour recurrence (p=<0.05). For disease progression, univariate analysis revealed high-grade tumour as the significant factor, whereas multivariate analysis showed prior recurrence rate as the dependent factor (p=<0.05). In our study population, probabilities of recurrence and progression were not comparable with the score described in CUETO.
Conclusion: Intravesical BCG remains as a valuable therapeutic option for high-risk NMIBC. However, our data revealed that patients with high-grade tumour and prior recurrence rate might be considered having the highest risk of recurrence and progression even after the BCG therapy. CUETO scoring system overestimates the rate of recurrence and progression in our population. So, in the future, another scoring model must be developed which should include smoking as one of the risk factors for tumour recurrence and progression.
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