Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up

Purpose The aim of this study was to evaluate the 10-year oncological outcomes of bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical bacillus Calmette-Guérin (BCG) instillation in selected patients with superficial muscle-invasive bladder cancer (MIBC). Mater...

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Main Authors: Dong Gyun Kim, Ji Eun Heo, Kang Su Cho, Jongsoo Lee, Won Sik Jang, Nam Hoon Cho, Young Deuk Choi
Format: Article
Language:English
Published: Korean Urological Oncology Society 2023-03-01
Series:Journal of Urologic Oncology
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Online Access:http://www.e-juo.org/upload/pdf/juo-21-1-70.pdf
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author Dong Gyun Kim
Ji Eun Heo
Kang Su Cho
Jongsoo Lee
Won Sik Jang
Nam Hoon Cho
Young Deuk Choi
author_facet Dong Gyun Kim
Ji Eun Heo
Kang Su Cho
Jongsoo Lee
Won Sik Jang
Nam Hoon Cho
Young Deuk Choi
author_sort Dong Gyun Kim
collection DOAJ
description Purpose The aim of this study was to evaluate the 10-year oncological outcomes of bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical bacillus Calmette-Guérin (BCG) instillation in selected patients with superficial muscle-invasive bladder cancer (MIBC). Materials and Methods Patients diagnosed with superficial MIBC (stage T2a) by TURBT between 2001 and 2009 were included. Cystectomy-free survival, recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify predictors of each type of survival. Results Of 145 patients, 135 underwent bladder preservation and 10 underwent immediate radical cystectomy (RC). Among the latter, 9 patients showed downstaging. During a median follow-up of 132 months (interquartile range, 96–161 months), 13 patients underwent RC, with a 10-year cystectomy-free survival rate of 83.9%. Seventy patients (48.3%) had recurrence, and the 10-year RFS rate was 48.9%. Progression occurred in 12 patients (8.3%), with a 10-year PFS rate of 90.1%. Death occurred only in patients who exhibited progression; 5 patients (3.4%) died of bladder cancer, and the 10-year CSS rate was 96.5%. Tumors greater than 3 cm were associated with RC, and a high tumor grade predicted recurrence. RC was related to progression and cancer-specific mortality. Conclusions Although high-grade tumors require careful follow-up, bladder preservation with TURBT and intravesical BCG instillation can enable the successful management of selected patients with stage T2a MIBC less than 3 cm, without carcinoma in situ or tumor-associated hydronephrosis, in a nonmetastatic setting.
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spelling doaj-art-e45bc2e37e5c4cc8a6ddc938b43dcb3f2024-12-03T04:12:19ZengKorean Urological Oncology SocietyJournal of Urologic Oncology2951-603X2982-70432023-03-01211707810.22465/juo.224400380019539Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-upDong Gyun Kim0Ji Eun Heo1Kang Su Cho2Jongsoo Lee3Won Sik Jang4Nam Hoon Cho5Young Deuk Choi6 Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Department of Pathology, Yonsei University College of Medicine, Seoul, Korea Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, KoreaPurpose The aim of this study was to evaluate the 10-year oncological outcomes of bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical bacillus Calmette-Guérin (BCG) instillation in selected patients with superficial muscle-invasive bladder cancer (MIBC). Materials and Methods Patients diagnosed with superficial MIBC (stage T2a) by TURBT between 2001 and 2009 were included. Cystectomy-free survival, recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify predictors of each type of survival. Results Of 145 patients, 135 underwent bladder preservation and 10 underwent immediate radical cystectomy (RC). Among the latter, 9 patients showed downstaging. During a median follow-up of 132 months (interquartile range, 96–161 months), 13 patients underwent RC, with a 10-year cystectomy-free survival rate of 83.9%. Seventy patients (48.3%) had recurrence, and the 10-year RFS rate was 48.9%. Progression occurred in 12 patients (8.3%), with a 10-year PFS rate of 90.1%. Death occurred only in patients who exhibited progression; 5 patients (3.4%) died of bladder cancer, and the 10-year CSS rate was 96.5%. Tumors greater than 3 cm were associated with RC, and a high tumor grade predicted recurrence. RC was related to progression and cancer-specific mortality. Conclusions Although high-grade tumors require careful follow-up, bladder preservation with TURBT and intravesical BCG instillation can enable the successful management of selected patients with stage T2a MIBC less than 3 cm, without carcinoma in situ or tumor-associated hydronephrosis, in a nonmetastatic setting.http://www.e-juo.org/upload/pdf/juo-21-1-70.pdfbcg vaccineorgan preservationsurvivaltransurethral resection of bladderurinary bladder neoplasms
spellingShingle Dong Gyun Kim
Ji Eun Heo
Kang Su Cho
Jongsoo Lee
Won Sik Jang
Nam Hoon Cho
Young Deuk Choi
Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
Journal of Urologic Oncology
bcg vaccine
organ preservation
survival
transurethral resection of bladder
urinary bladder neoplasms
title Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
title_full Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
title_fullStr Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
title_full_unstemmed Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
title_short Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
title_sort bladder preservation with transurethral tumor resection and intravesical bcg instillation in superficial muscle invasive bladder cancer a 10 year follow up
topic bcg vaccine
organ preservation
survival
transurethral resection of bladder
urinary bladder neoplasms
url http://www.e-juo.org/upload/pdf/juo-21-1-70.pdf
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