Prognostic Factors in Patients Treated with Intravesical Bacillus Calmette-Guerin for Superficial Bladder Cancer

Abstract

Several factors were evaluated for prognostic significance in 104 patients with a history of recurrent superficial bladder cancer treated with a 6-week course of intravesical bacillus Calmette-Guerin. Purified protein derivative skin test reactivity, tumor stage, tumor grade and number of previous tumor recurrences were evaluated in all patients. In addition, the prognostic value of a granulomatous response in the bladder was evaluated in 62 of the 104 patients. A significant correlation was reconfirmed between purified protein derivative reactivity and status free of tumor (p equals 0.041) after additional followup on 62 patients from a previous report. A significant correlation also was observed in the total patient population (p equals 0.054). Over-all, 60 per cent of the 62 patients and 52 per cent of the 104 patients whose purified protein derivative test converted from negative to positive remained free of tumor, compared to only 28 per cent of the 62 patients and 28 per cent of the 104 whose test failed to convert to positive. Mean followup was 29.3 +/- 5.7 months in the 62 patient subgroup and 23.5 +/- 5.8 months in the total 104 patients. Bladder granuloma data were available only for the 62 patient subgroup in the previous report. With extended followup, the significant correlation previously reported between status free of tumor and granulomatous response on bladder biopsy was lost. Over-all, 29 of 37 patients (51 per cent) with granulomas compared to 8 of 25 (32 per cent) without granulomas remained free of tumor (p equals 0.132). Tumor stage and grade, and number of previous tumor recurrences failed to show a significant correlation to status free of tumor. These results show that with extended followup, granulomatous response in the bladder lost its statistical correlation with status free of tumor, while a significant correlation was maintained for purified protein derivative responsiveness. This level of statistical significance was borderline and the purified protein derivative skin test response should not be considered useful as a prognostic indicator in individual patients.

Evaluation of Cellular Immunity following Bacillus Calmette-Guérin Therapy in Patients with Superficial Bladder Cancer

“…However, the absence of a clinical response of the subpopulation of patients is not clearly understood, explaining the interest in basic research con cerning BCG-associated antitumor activity and the search for prognostic factors. Several factors such as PPD skin test response and granulomatous response in bladder have been evaluated as potential prognostic indicators of response to BCG therapy [3,5,8,24]. New prognostic indicators with sufficient specificity to identify nonres ponders early must be developed.…”

Use of Maintenance Intravesical Bacillus Calmette-Guérin (BCG), with or without Intradermal BCG, in Patients with Recurrent Superficial Bladder Cancer

“…However, especially for side effects, this may be due to the small numbers of patients in both groups. In some studies conversion of the PPD test seems to indicate abetter response to therapy [6,11,21,22], although the significance of this test is boderline. It should not be used as a prognostic marker in indi vidual patients [22].…”

“…In some studies conversion of the PPD test seems to indicate abetter response to therapy [6,11,21,22], although the significance of this test is boderline. It should not be used as a prognostic marker in indi vidual patients [22]. In the present study, PPD skin reac tion conversion had no correlation with tumor recur rences, although our number of patients is limited.…”

Role of the Immune Response in BCG for Bladder Cancer

“…The first is direct recognition of tumour-cell antigens which results in the pro duction of cytotoxic T-lymphocytes (Tc), production of cytokines from helper T-cell (Th) (these cells also can be cytolytic) or tumour-specific antibodies. The second is a cytokine Macrophage correlating both DTH and granulomatous inflammation have shown a low correlation which suggests independence of the antitumour mechanism or a partial contribution [7,18].…”