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Radical cystectomy for BCG failure: has the timing improved in recent years?
Author(s) -
Soloway Mark S.,
Hepps David,
Katkoori Devendar,
Ayyathurai Rajinikanth,
Manoharan Murugesan
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09830.x
Subject(s) - cystectomy , medicine , bladder cancer , pathological , stage (stratigraphy) , carcinoma in situ , urology , retrospective cohort study , surgery , cancer , paleontology , biology
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.