The Natural History Of Bladder Carcinoma In Situ After Initial Response To Bacillus Calmete-Gúerin Immunotherapy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 30 Jun 2008 - 1:00 PST

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ORLANDO, FL (UroToday.com) - The authors explored patterns of recurrence, muscle invasion, and disease specific mortality in patients with bladder carcinoma in situ (CIS) who responded to an induction course with intravesical BCG immunotherapy.

Between June 1985 and December 2003, 104 patients (mean age of 67 years) were diagnosed with either pure (38 patients) or concomitant (66 patients) CIS. Patients who responded to one (92 patients) or two (12 patients) induction courses of intravesical BCG instillation were included in the study. Response was determined and monitored by routine periodic bladder biopsies. Patients outcome and the effect of various prognostic parameters were assessed after a median follow-up of 75 months.

5-year
Recurrence-free 64% Progression-free 79% Cancer-Specific Survival 90%
10-year
Recurrence-free 54% Progression-free 77% Cancer-Specific Survival 86%

Median time to recurrence, muscle invasion and disease-specific mortality was 18, 19 and 40 months respectively. Pure and concomitant CIS were associated with a similar outcome. The recurrence of non-muscle invasive tumor did not increase the risk for muscle invasion or mortality. The authors concluded that 14% of patients with CIS who have a complete response to an induction course of BCG will die of their cancer after 10 years. Muscle-invasive disease is expected in about 27% of the BCG responders.

Presented by Ofer N Gofrit, MD, Dov Pode, MD, Galina Pizov, MD, Kevin C Zorn, MD, Ran Katz, MD, Mordechi Duvdevani, MD, Amos Shapiro, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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