High risk non muscle invasive bladder cáncer: more options than BCG?
Authors: García Álvarez C.;Plata Bello A.C.; Plata Bello J.; González Álvarez R.J.; González Pérez L.; Cabral Fernández A.V.; Cereijo Tejedor D.; Navarro Galés M.A.; Concepción Masip T.
Department of Urology. University Hospital of Canary Island, Spain.
BCG instillations (induction+maintenance) are the gold standard treatment for high risk non muscle invasive bladder cancer (HRNMIBC). Recently BCG shortage in Europe has been a challenge in the management of these patients. BCG dose reduction, mitomycin-chemohyperthermia and early cystectomy are alternatives to BCG standard treatment. The aim is to evaluate recurrence free survival (RFS) and progresión free survival (PFS) in HRNMIBC patients treated with different options during the lack of BCG.
MATERIALS AND METHODS
Singlecenter retrospective analysis of 81 HRNMIBC patients. Epidemiological (age, gender, smoking status), clinical and pathological features (TNM, grade, size and number tumors, presence of CIS, recurrent tumor, re-TUR status and type of intravesical treatment) were considered. We perform a descriptive analysis and Cox-regression analysis to evaluate the effect of the different factors considered using SPSS v19.0. Statistical signification considered p value<0.05.
We included 81 patientes diagnosed of HRNMIBC of which 7.4% had concomitant CIS. Mean follow up was 54 months. 95.1% were re-staging in re-TUR (without tumor in 54.2% of cases). 71.6% recieved intravesical instillations: 19,8% MMC-chemohyperthermia (induction+maintenance), 42% BCG (induction+maintenance) and 9% 6-weekly BCG-induction followed by 8 monthly MMC-chemohyperthermia.
After a mean follow up of 54 months the RFS of the global cohort was 39 months (23,4-45,5) and PFS was 77 months (45,3-82,6). In the univariate COX regression analysis only the absence of CIS was identified as protective factor for recurrence (HR: 0,1, CI95%: 0,03-0,89 p=0,03). The rest of the variables studied, including the different alternatives of instillations didn’t show to be risk factors for recurrence/progression in our experience.
MMC-chemohyperthermia appears to be a promising alternative to BCG that does not worsen short-term oncological outcomes in HRNMIBC. The presence of CIS is a risk factor of recurrence independent of the intravesical treatment.