Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer
To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC). Pre-specified data elements were collected from retrospective cohorts of patients wi...
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| creator | Taylor, Jacob I Kamat, Ashish M O'Donnell, Michael A Annapureddy, Drupad Howard, Jeffrey Tan, Wei Shen McElree, Ian Davaro, Facundo Yim, Kendrick Harrington, Stephen Dyer, Elizabeth Black, Anna J Kanabur, Pratik Roumiguié, Mathieu Lerner, Seth Black, Peter C Raman, Jay D Preston, Mark A Steinberg, Gary Huang, William Li, Roger Packiam, Vignesh T Woldu, Solomon L Lotan, Yair |
| description | To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).
Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.
Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).
In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST. |
| doi_str_mv | 10.1111/bju.16509 |
| format | Article |
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Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.
Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).
In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.</description><identifier>ISSN: 1464-410X</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/bju.16509</identifier><identifier>PMID: 39183466</identifier><language>eng</language><publisher>England</publisher><ispartof>BJU international, 2024-08</ispartof><rights>2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-1274-7200 ; 0000-0002-2412-146X ; 0000-0001-5692-2723 ; 0000-0002-0196-3875 ; 0000-0001-9991-4301 ; 0000-0001-7202-6427 ; 0000-0003-2190-7309</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39183466$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taylor, Jacob I</creatorcontrib><creatorcontrib>Kamat, Ashish M</creatorcontrib><creatorcontrib>O'Donnell, Michael A</creatorcontrib><creatorcontrib>Annapureddy, Drupad</creatorcontrib><creatorcontrib>Howard, Jeffrey</creatorcontrib><creatorcontrib>Tan, Wei Shen</creatorcontrib><creatorcontrib>McElree, Ian</creatorcontrib><creatorcontrib>Davaro, Facundo</creatorcontrib><creatorcontrib>Yim, Kendrick</creatorcontrib><creatorcontrib>Harrington, Stephen</creatorcontrib><creatorcontrib>Dyer, Elizabeth</creatorcontrib><creatorcontrib>Black, Anna J</creatorcontrib><creatorcontrib>Kanabur, Pratik</creatorcontrib><creatorcontrib>Roumiguié, Mathieu</creatorcontrib><creatorcontrib>Lerner, Seth</creatorcontrib><creatorcontrib>Black, Peter C</creatorcontrib><creatorcontrib>Raman, Jay D</creatorcontrib><creatorcontrib>Preston, Mark A</creatorcontrib><creatorcontrib>Steinberg, Gary</creatorcontrib><creatorcontrib>Huang, William</creatorcontrib><creatorcontrib>Li, Roger</creatorcontrib><creatorcontrib>Packiam, Vignesh T</creatorcontrib><creatorcontrib>Woldu, Solomon L</creatorcontrib><creatorcontrib>Lotan, Yair</creatorcontrib><title>Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).
Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.
Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).
In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.</description><issn>1464-410X</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpNUMFKxDAUDKK4unrwByRHL1mTTZu2R110FRa8KHgr6cvr2qVNatIs1K-36ArO4c0wDAPzCLkSfCEm3Fa7uBAq5cUROROJSlgi-PvxPz0j5yHsOJ8MlZ6SmSxELid9Rr42zm7ZgL6jLg7gOgzU1bRqtTHoWei1b-yWDh_odT_SfaBemwZ0S2EMA8LgupE2lt6v1ixaj6F3NjR7pNZZ1sUALbLG7vWPd2iloC2gvyAntW4DXh54Tt4eH15XT2zzsn5e3W1YLxIxMMiUgsTg0ijgaV0sq0wqwDydDmTTaFSFkUmeCoGCZ8B1VUtV5FyB5Jnhck5ufnt77z4jhqHsmgDYttqii6GUvMhEmi6LZIpeH6Kx6tCUvW867cfy71_yG8tvbe8</recordid><startdate>20240825</startdate><enddate>20240825</enddate><creator>Taylor, Jacob I</creator><creator>Kamat, Ashish M</creator><creator>O'Donnell, Michael A</creator><creator>Annapureddy, Drupad</creator><creator>Howard, Jeffrey</creator><creator>Tan, Wei Shen</creator><creator>McElree, Ian</creator><creator>Davaro, Facundo</creator><creator>Yim, Kendrick</creator><creator>Harrington, Stephen</creator><creator>Dyer, Elizabeth</creator><creator>Black, Anna J</creator><creator>Kanabur, Pratik</creator><creator>Roumiguié, Mathieu</creator><creator>Lerner, Seth</creator><creator>Black, Peter C</creator><creator>Raman, Jay D</creator><creator>Preston, Mark A</creator><creator>Steinberg, Gary</creator><creator>Huang, William</creator><creator>Li, Roger</creator><creator>Packiam, Vignesh T</creator><creator>Woldu, Solomon L</creator><creator>Lotan, Yair</creator><scope>NPM</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1274-7200</orcidid><orcidid>https://orcid.org/0000-0002-2412-146X</orcidid><orcidid>https://orcid.org/0000-0001-5692-2723</orcidid><orcidid>https://orcid.org/0000-0002-0196-3875</orcidid><orcidid>https://orcid.org/0000-0001-9991-4301</orcidid><orcidid>https://orcid.org/0000-0001-7202-6427</orcidid><orcidid>https://orcid.org/0000-0003-2190-7309</orcidid></search><sort><creationdate>20240825</creationdate><title>Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer</title><author>Taylor, Jacob I ; 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Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.
Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).
In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.</abstract><cop>England</cop><pmid>39183466</pmid><doi>10.1111/bju.16509</doi><orcidid>https://orcid.org/0000-0003-1274-7200</orcidid><orcidid>https://orcid.org/0000-0002-2412-146X</orcidid><orcidid>https://orcid.org/0000-0001-5692-2723</orcidid><orcidid>https://orcid.org/0000-0002-0196-3875</orcidid><orcidid>https://orcid.org/0000-0001-9991-4301</orcidid><orcidid>https://orcid.org/0000-0001-7202-6427</orcidid><orcidid>https://orcid.org/0000-0003-2190-7309</orcidid><oa>free_for_read</oa></addata></record> |
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| title | Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer |
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