Prognostic Factors in Patients with Non–Muscle-Invasive Bladder Cancer Treated with Bacillus Calmette-Guérin: Multivariate Analysis of Data from Four Randomized CUETO Trials

Fernandez-Gomez, Jesus; Solsona, E.; Unda, Miguel; Martínez‐Piñeiro, Luis; Gonzalez, M. S.; Hernández, R.; Madero, Rosário; Ojea, A; Pertusa, C; Rodríguez‐Molina, Jesús; Camacho, José Emilio; Isorna, Santiago; Rabadán, M; Astobieta, Ander; Montesinos, M.; Muntañola, Pedro; Gimeno, A.; Blas, Miguel; Martínez-Piñeiro, J A

doi:10.1016/j.eururo.2007.10.006

Cited by 232 publications

(186 citation statements)

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“…Several clinicopathological tumor characteristics have recently been suggested as predictors for recurrence and progression after BCG therapy. 7 However, clinicopathological or molecular markers that can reliably predict failure or success of BCG therapy are still lacking. 8 Such markers would be of great value to individually tailor the follow-up schedule and stratify patients at high risk of tumor recurrence or progression.…”

Section: Uiccmentioning

confidence: 99%

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Savic

Zlobec

Thalmann

et al. 2009

Intl Journal of Cancer

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Molecular markers reliably predicting failure or success of Bacillus Calmette-Guerin (BCG) in the treatment of nonmuscle-invasive urothelial bladder cancer (NMIBC) are lacking. The aim of our study was to evaluate the value of cytology and chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in predicting failure to BCG therapy. Sixty-eight patients with NMIBC were prospectively recruited. Bladder washings collected before and after BCG instillation were analyzed by conventional cytology and by multitarget FISH assay (UroVysion 1 , Abbott/ Vysis, Des Plaines, IL) for aberrations of chromosomes 3, 7, 17 and 9p21. Persistent and recurrent bladder cancers were defined as positive events during follow-up. Twenty-six of 68 (38%) NMIBC failed to BCG. Both positive post-BCG cytology and positive post-BCG FISH were significantly associated with failure of BCG (hazard ratio (HR)5 5.1 and HR5 5.6, respectively; p < 0.001 each) when compared to those with negative results. In the subgroup of nondefinitive cytology (all except those with unequivocally positive cytology), FISH was superior to cytology as a marker of relapse (HR5 6.2 and 1.4, respectively). Cytology and FISH in post-BCG bladder washings are highly interrelated and a positive result predicts failure to BCG therapy in patients with NMIBC equally well. FISH is most useful in the diagnostically less certain cytology categories but does not provide additional information in clearly malignant cytology. ' UICCKey words: nonmuscle-invasive urothelial bladder cancer; Bacillus Calmette-Guerin; cytology; fluorescence in situ hybridization High-and intermediate risk nonmuscle-invasive urothelial bladder cancers (NMIBC) frequently recur and, more importantly, can progress to potentially life-threatening muscle-invasive carcinomas. Intravesical instillation of Bacillus Calmette-Guerin (BCG) after transurethral resection of bladder cancer (TURB) is the most effective treatment. However, 50% of NMIBC do not respond to BCG treatment. [1][2][3] The progression rate has been estimated to be 9.8%, and 5.6% of patients with NMIBC die from bladder cancer. 4 Although an early cystectomy provides an excellent chance of cure, 50% of patients are overtreated with this aggressive approach. 5,6 Decision on therapy strategy of bladder cancer is based on clinicopathological tumor characteristics (number of tumors, tumor size, prior recurrence rate, tumor category, presence of pTis and tumor grade). Several clinicopathological tumor characteristics have recently been suggested as predictors for recurrence and progression after BCG therapy. 7 However, clinicopathological or molecular markers that can reliably predict failure or success of BCG therapy are still lacking. 8 Such markers would be of great value to individually tailor the follow-up schedule and stratify patients at high risk of tumor recurrence or progression.Although conventional cytology has a very high diagnostic accuracy for high-grade urothelial carcinomas, false-positive results have been repor...

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Section: Uiccmentioning

confidence: 99%

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Savic

Zlobec

Thalmann

et al. 2009

Intl Journal of Cancer

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“…El análisis descriptivo de ambas series revela que el porcentajes de recidiva en ambas centros (48.8% y 56.6%) es similar al de otras series históricas publicadas [10][11][12][13][14][15][16], sin embargo el porcentaje de progresión es menor que en otros estudios [1, 14,[16][17][18] Los factores pronósticos para una primera recidiva son equivalentes al de otras series e incluyen la edad, grado, número y tamaño tumoral junto con el tratamiento. Tanto la presencia de cis como el estadio tumoral, no fueron significativos para la recidiva tumoral [17].…”

Section: Discussionunclassified

“…Tanto la presencia de cis como el estadio tumoral, no fueron significativos para la recidiva tumoral [17]. Al analizar el resultado con las extensiones del modelo de Cox observamos que tras una nueva recidiva el riesgo de presentar un nuevos episodios se incrementa un 45%.…”

Section: Discussionunclassified

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Cálculo del riesgo biológico de multirrecidiva y progresión del carcinoma urotelial no músculo-invasivo mediante nuevos modelos matemáticos

Marco

Santamaría

Pontones

et al. 2014

Actas Urológicas Españolas

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“…Recent multivariate analyses based on large, multicenter bladder cancer patient cohorts of greater than 1,000 patients have suggested some independent predictors for recurrence and progression after BCG induction and short-term maintenance treatment [19]. Analysis from a Spanish group with 1,062 patients with NMIBC suggested that female gender, history of recurrence, multiplicity, and presence of CIS are predictors for recurrence, and age, history of recurrence, high grade, T1 stage, and recurrence at initial cystoscopy are predictors for progression [19].…”

Section: Demographic Predictorsmentioning

confidence: 99%

Management of BCG Failures in Non-Muscle-Invasive Bladder Cancer

Han

Hong

2009

Korean J Urol

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Purpose: Bacillus Calmette-Guérin (BCG) intravesical therapy is the standard treatment in high-risk patients with non-muscle-invasive bladder cancer, but a significant number of patients experience recurrence after BCG therapy. Although several treatment options are available for recurrence after BCG therapy, the optimal treatment strategy is still controversial. We reviewed current and promising treatment options after BCG failure. Materials and Methods: A search of published literature using PubMed and meeting abstracts was performed. Results: BCG failures are further subdefined as BCG refractory, BCG resistant, BCG relapsing, and BCG intolerance. Several predictors for BCG response have been studied, but prediction or stratification before therapy seems to be difficult in clinical practice. Novel biomarkers associated with immunologic mechanisms appear to be promising to predict BCG failure. Radical cystectomy is the standard treatment for BCG-refractory disease, but the timing of cystectomy is controversial. BCG maintenance or combination with interferon-α is a promising therapy for BCG resistance or relapse. Some salvage therapies or device-assisted instillations have been also promising, but the efficacy and safety of these novel therapies should be confirmed by large prospective studies before their clinical use in BCG failure. Conclusions: Patients with BCG failure are not a homogeneous group and need to be stratified. Radical cystectomy should be performed without delay in patients with BCG-refractory status, but salvage intravesical therapies may be an alternative in cases without true refractory status. Although BCG and interferon intravesical therapy is promising, more efficient salvage therapy after BCG failure is required. (Korean J Urol 2009;50:1037-1047)

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Prognostic Factors in Patients with Non–Muscle-Invasive Bladder Cancer Treated with Bacillus Calmette-Guérin: Multivariate Analysis of Data from Four Randomized CUETO Trials

Cited by 232 publications

References 41 publications

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Cálculo del riesgo biológico de multirrecidiva y progresión del carcinoma urotelial no músculo-invasivo mediante nuevos modelos matemáticos

Management of BCG Failures in Non-Muscle-Invasive Bladder Cancer

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