Outcomes of BCG vs upfront radical cystectomy for high-risk non-muscle-invasive bladder cancer.

• Tác giả: Luca Afferi, Simone Albisinni, Javier Aranda, Alberto Briganti, Jorge Caño Velasco, Roberto Contieri, David D'Andrea, Mario de Angelis, Francesco Del Giudice, Andrea Gallioli, Paolo Gontero, Rodolfo Hurle, Wojciech Krajewski, Ekaterina Laukhtina, Mattia Longoni, Gautier Marcq, Andrea Mari, Riccardo Mastroianni, Laura S Mertens, Francesco Montorsi, Keiichiro Mori, Marco Moschini, Andrea Necchi, Katharina Oberneder, Renate Pichler, Benjamin Pradere, Alfonso Lafuente Puentedura, Piotr Radziszewski, José Luis Rodríguez Elena, Morgan Rouprêt, Andrea Salonia, Pietro Scilipoti, Shahrokh F Shariat, Giuseppe Simone, Aleksander Ślusarczyk, Francesco Soria, José Daniel Subiela, Paolo Zaurito
• Ngôn ngữ: eng
• Ký hiệu phân loại: 633.15 *Com
• Thông tin xuất bản: England : BJU international , 2025
• Bộ sưu tập: NCBI
• ID: 208251

Tóm tắt

 OBJECTIVE: To assess the oncological outcomes of patients with high-risk (HR) and very high-risk (VHR) non-muscle-invasive bladder cancer (NMIBC) treated with upfront radical cystectomy (RC) vs Bacillus Calmette-Guérin (BCG) instillations from a contemporary European multicentre cohort. PATIENTS AND METHODS: We conducted a retrospective analysis of 1491 patients diagnosed with HR- or VHR-NMIBC from a European multicentre database between 2015 and 2024. Patients were included if they received either upfront RC or at least five doses of BCG. A 1:1 propensity score matching (PSM) according to clinically relevant variables was applied. Progression was defined as muscle-invasive or metastatic disease. Cumulative incidence plots and multivariable competing risk regression models addressing cancer-specific mortality (CSM) were fitted. RESULTS: Among the 1221 patients with HR- (n = 1221 [90%]) or VHR-NMIBC (n = 121 [10%]), 87 (7.1%) underwent upfront RC. The median follow-up was 2.6 years. After PSM (87 vs 87 patients), the 5-year CSM rate was similar in patients treated with BCG (13%) vs their upfront RC counterparts (16%) (hazard ratio: 1.77, 95% confidence interval [CI] 0.66-4.73
  P = 0.3). Of the 1134 patients who initially received BCG, 73 (6.6%) eventually required delayed RC, with 34 (47%) progressing to muscle-invasive bladder cancer before delayed RC. The 3-year CSM rate was comparable in upfront RC (13%) vs delayed RC (11%) among non-progressing patients (P = 0.3). However, patients who progressed before delayed RC had worse 3-year CSM relative to those who did not (13% vs 31%, hazard ratio: 0.32, 95% CI 0.13-0.83
  P = 0.018). CONCLUSION: Within a European cohort of patients with HR- and VHR-NMIBC, upfront RC was rarely performed. Patients treated with BCG did not exhibit a CSM disadvantage relative to their upfront RC counterparts. After matching, long-term CSM was similar between BCG therapy and upfront RC. Delayed RC, led to worse outcomes if performed after progression, but matched upfront RC when performed before progression, underscoring importance of timely surgery.