Login to Access Video or Poster Abstract: MP15-09
Sources of Funding: Cancer Center Support Grant

Introduction

Patients who have a tumor recurrence after treatment with intravsical BCG are considered as high risk for additional recurrence or disease progression. We have previously shown that low grade (LG) papillary recurrence found at the 3 month post-BCG evaluation is highly predictive of future outcome; here we further elucidate whether this prognostic impact holds true at any time during or after intravesical BCG treatment.

Methods

After IRB approval, we studied a group of 155 patients with intermediate to high risk, NMIBC undergoing TURBT and subsequent intravesical BCG treatment according to the SWOG protocol. Patients with recurrences after BCG were identified. Baseline demographics and clinical characteristics prior to BCG were compared. Cystectomy-free (CFS), metastasis-free (MFS), cancer specific (CSS) and overall survivals (OS) between the groups were compared using the Log-rank test. Statistical significance was set at p<0.05.

Results

A total of 17 patients with LG and 53 patients with HG recurrences were identified with median follow-up intervals of 68.9 and 60 months, respectively. The two groups were comparable for baseline clinico-pathologic features except that more patients with HG recurrences started with higher stage (32.7% Ta, 65.4% T1 and 1.9% CIS vs. 70.6% Ta, 29.4% T1 and 0% TIS, p=0.018) and grade (60% HG and 40% LG vs. 98% HG and 2% LG, p<0.001) on TURBT prior to BCG treatment. As expected, more patients with HG recurrence underwent cystectomy (54.7% vs. 17.6%, p=0.011) (Fig. 1a) while those with LG recurrences continued on BCG after recurrence in 82.4% of the cases. This management paradigm yielded similar MFS, CSS, and OS (Fig. 1b, c, d).

Conclusions

Patients with LG recurrence after BCG treatment have excellent outcomes and can continue with bladder sparing therapy. Patients with HG recurrence after BCG treatment are more likely to undergo radical salvage cystectomy. With appropriately selected therapy, metastatic disease can be prevented, leading to similar CSS and OS as seen for those with LG recurrence.

Funding

Cancer Center Support Grant