European Urology

Abstract

Objectives

To evaluate the prognostic factors of recurrence and progression after intravesical adjuvant bacillus Calmette-Guérin (BCG) immunotherapy in patients with non–muscle-invasive bladder tumors.

Methods

From February 1990 to May 1999, the Spanish Club Urológico Español de Tratamiento Oncológico (CUETO) group has performed four randomized phase 3 studies comparing different intravesical treatments in patients with noninvasive bladder cancer. Data from 1062 evaluable patients treated only with BCG were analyzed. Most patients received BCG once weekly for 6 consecutive weeks and a short-term BCG maintenance (once every 2 wk 6 times more). Associated tumor in situ (TIS) was found in 7.5% (n = 80) of cases. There were 22.1% (n = 235) patients with T1G3 tumors, 22.9% of whom (n = 54) were associated with TIS. Stepwise multivariate Cox regression models with stratification by study and dose were used to assess the independent effect of predictive factors and hazard ratios (HRs) were estimated from the Cox model.

Results

Multivariate analysis demonstrated that female gender (HR = 1.71) compared to male gender, recurrent tumors (HR = 1.9) compared to primary tumors, multiplicity, and presence of associated TIS (HR = 1.54) increased the risk of recurrence. Recurrent tumors (HR = 1.62) compared to primary tumors, high-grade tumors (HR = 5.64) compared to G1 tumors, T1 tumors (HR = 2.15) compared to Ta tumors, and recurrence at 3-mo cystoscopy (HR = 4.6) increased the risk of progression.

Conclusion

Significant independent predictors for recurrence were female gender, history of recurrence, multiplicity, and presence of associated TIS. Age, history of recurrence, high grade, T1 stage, and recurrence at first cystoscopy were independent predictors of progression by multivariate Cox analysis.

Take Home Message

This is the first study to analyze prognostic factors in patients receiving bacillus Calmette-Guérin (BCG) with large number of patients and long follow-up. History of recurrence, T1, high grade, and early recurrence were the most important prognostic factors in patients receiving BCG immunotherapy.