Prognostic Factors and Risk Groups in T1G3 Non–Muscle-invasive Bladder Cancer Patients Initially Treated with Bacillus Calmette-Gue´ rin: Results of a retrospective Multicenter Study of 2451 Patients

Vincenzo Serretta, Kathy Vander Eeckt, Stéphane Larré, Marco Oderda, Anne J. Grotenhuis, Evanguelos Xylinas, Alfred J. Witjes, Roy Mano, Joan Palou, Eugene K. Cha, Tommaso Cai, Lambertus A. Kiemeney, Bas Van Rhijn, Steven Joniau, R. Jeffrey Karnes, Peter Ardelt, Marek Babjuk, Martin Spahn, John Varkarakis, Paolo GonteroNuria Malats, Guido Dalbagni, Per-Uno Malmström, Shahrokh F. Shariat, Savino Di Stasi, Riccardo Bartoletti, Francesca Pisano, Joan Palou, Bruno Frea, Jacques Irani, Vincenzo Serretta, Jack Baniel, Renzo Colombo, Richard Sylvester, Robert Johansson, Tommaso Cai, Viktor Soukup, Alberto Briganti

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Abstract

Background: The impact of prognostic factors in T1G3 non–muscle-invasive bladdercancer (BCa) patients is critical for proper treatment decision making.Objective: To assess prognostic factors in patients who received bacillus Calmette-Gue´ rin (BCG) as initial intravesical treatment of T1G3 tumors and to identify a subgroupof high-risk patients who should be considered for more aggressive treatment. Design, setting, and participants: Individual patient data were collected for 2451 T1G3patients from 23 centers who received BCG between 1990 and 2011.Outcome measurements and statistical analysis: Using Cox multivariable regression,the prognostic importance of several clinical variables was assessed for time to recurrence,progression, BCa-specific survival, and overall survival (OS).Results and limitations: With a median follow-up of 5.2 yr, 465 patients (19%) progressed,509 (21%) underwent cystectomy, and 221 (9%) died because of BCa. Inmultivariable analyses, the most important prognostic factors for progression wereage, tumor size, and concomitant carcinoma in situ (CIS); the most important prognosticfactors for BCa-specific survival and OS were age and tumor size. Patients were dividedinto four risk groups for progression according to the number of adverse factors amongage 70 yr, size 3 cm, and presence of CIS. Progression rates at 10 yr ranged from 17%to 52%. BCa-specific death rates at 10 yr were 32% in patients 70 yr with tumor size 3 cm and 13% otherwise.Conclusions: T1G3 patients 70 yr with tumors 3 cm and concomitant CIS should betreated more aggressively because of the high risk of progression.Patient summary: Although the majority of T1G3 patients can be safely treated withintravesical bacillus Calmette-Gue´ rin, there is a subgroup of T1G3 patients with age 70 yr, tumor size 3 cm, and concomitant CIS who have a high risk of progression andthus require aggressive treatment.
Original languageEnglish
Pages (from-to)74-82
Number of pages9
JournalEuropean Urology
Volume67
Publication statusPublished - 2015

All Science Journal Classification (ASJC) codes

  • Urology

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