INTRODUCTION: There are few studies on the factors that influence progression in T1G3 tumors treated with BCG.
Lymphovascular permeation is not recognized as a prognostic factor for progression in the clinical guidelines of the European Association of Urology, but in the American Association of Urology 2016
MATERIAL AND METHOD: 128 patients treated with 81 mg of BCG in our service from 2000 to 2010. The demographic and tumor characteristics are the following: mean age 67 years, males 111 (87%), primaries 86 (67%), multiple 61 (47.7%), volume> 3 cc 64 (50%), Tis associated 20 (16%), LINFOVASCULAR PERMEATION (L1) 21 (15%), maintenance of BCG 88 (68.7%)
RTU macroscopically complete. Immunoprophylaxis with 81 mg BCG Connaught. Induction of six weeks followed or not by maintenance. The maintenance was at least one year but with different guidelines (a single quarterly instillation, three instillations quarterly monthly instillations).
Follow-up of patients according to the usual protocol in our service: quarterly for the first two years, semi-annually for the next three years and annual from the fifth. Cystoscopy, ultrasound, cytology, study of the upper appliance according to need
The statistical study was carried out with the SPSS 18 program
RESULTS: The T.L.E. mean as a whole is 60.1 (3-194) months with a median of 40.5 months. T.L.E. average of those who progress is 17.3 months versus 68.3 months of those who do not (p.0010). Median of 11.5 and 62.5 months respectively. The average time to progression is 11.5 months in the L0 and 11.8 months in the L1 (median of 10, 5 and 5 months respectively)
22 patients (17.2%) have progressed to infiltrating muscle stage.
13.5% of L0 have progressed compared to 41.2% of L1. The difference is statistically significant (p.101) with a relative risk of 5.0 of progression for L1 versus L0
In the univariate study for progression, only the lymphatic permeation reaches statistical significance (p.011).
In the multivariate study, the only independent factor is lymphovascular permeation ((p.006), OR 5.002 (1.57-15.92)) and in the Cox regression ((p.004) HR 3.793 (1.457-9.872) )
Lymphovascular permeation has a 3.8 times higher risk of progression than L0 after treatment with BCG.
In our opinion, it should be included within the prognostic factors