Urologic oncology · 2026
Evaluating BCG response in primary and metachronous non-muscle invasive bladder cancer following prior upper tract urothelial cancer: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Tan Yu Guang, Fong Khi Yung, Abern Michael R, Lim Benjamin Jia Han, Leow Jeffrey Jj, Chong Tsung Wen, Tay Kae Jack, Chen Kenneth, Yuen John Sp, Chan Johan, Chan Jason Ys, Hussain Syed A, Teoh Jeremy Yc, Kamat Ashish M
Аннотация
INTRODUCTION: Emerging evidence suggests that metachronous non-muscle invasive bladder cancer (m-NMIBC) recurrence after prior upper tract urothelial carcinoma (UTUC) treatment is distinct from primary NMIBC (p-NMIBC). Correspondingly, their disease trajectories and treatment responses may differ vastly. This systematic review aims to evaluate the differences in Bacillus Calmette-Guérin (BCG) response between m-NMIBC and p-NMIBC.
METHODS: A comprehensive literature search (PubMed, Embase, and Scopus) was performed to identify relevant studies that reported BCG outcomes for p-NMIBC and m-NIMBC. Endpoints analyzed were high-grade recurrence-free survival (HG-RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). This study followed the PRISMA guidelines. Both one-stage and two-stage meta-analyses were performed.
RESULTS: Six cohort studies with 1,292 patients were identified. Three studies utilized propensity-matched scoring to account for differences in baseline clinical characteristics. BCG prescription was observed in 89% of the whole cohort, with 4 studies treating all included patients with BCG. Patients with m-NMIBC demonstrated worse HG-RFS (one-stage meta-analysis: HR 0.47, 95% CI 0.38-0.59, P < 0.001; two-stage meta-analysis: HR 0.44, 95% CI 0.38-0.50, P < 0.001, I² = 0%). M-NMNIBC also demonstrated worse PFS compared to p-NMIBC (one-stage meta-analysis: HR 0.54, 95% CI 0.35-0.83, P = 0.005; two-stage meta-analysis: HR 0.45, 95% CI 0.22-0.90, P = 0.035, I² = 0%). There were no significant differences for CSS (one-stage meta-analysis: HR 0.53, 95% CI 0.24-1.17, P = 0.116) and OS (one-stage meta-analysis: HR 1.24, 95% CI 0.64-2.42, P = 0.520). Overall risk of bias was moderate across the included studies.
CONCLUSIONS: This review observed that m-NMIBC exhibits a poorer response to BCG compared to p-NMIBC, with significantly higher rates of HG-recurrence and disease progression. These observations reflect a potential biological distinction between the 2 entities, and highlight important implications in clinical trial design and risk stratification.
METHODS: A comprehensive literature search (PubMed, Embase, and Scopus) was performed to identify relevant studies that reported BCG outcomes for p-NMIBC and m-NIMBC. Endpoints analyzed were high-grade recurrence-free survival (HG-RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). This study followed the PRISMA guidelines. Both one-stage and two-stage meta-analyses were performed.
RESULTS: Six cohort studies with 1,292 patients were identified. Three studies utilized propensity-matched scoring to account for differences in baseline clinical characteristics. BCG prescription was observed in 89% of the whole cohort, with 4 studies treating all included patients with BCG. Patients with m-NMIBC demonstrated worse HG-RFS (one-stage meta-analysis: HR 0.47, 95% CI 0.38-0.59, P < 0.001; two-stage meta-analysis: HR 0.44, 95% CI 0.38-0.50, P < 0.001, I² = 0%). M-NMNIBC also demonstrated worse PFS compared to p-NMIBC (one-stage meta-analysis: HR 0.54, 95% CI 0.35-0.83, P = 0.005; two-stage meta-analysis: HR 0.45, 95% CI 0.22-0.90, P = 0.035, I² = 0%). There were no significant differences for CSS (one-stage meta-analysis: HR 0.53, 95% CI 0.24-1.17, P = 0.116) and OS (one-stage meta-analysis: HR 1.24, 95% CI 0.64-2.42, P = 0.520). Overall risk of bias was moderate across the included studies.
CONCLUSIONS: This review observed that m-NMIBC exhibits a poorer response to BCG compared to p-NMIBC, with significantly higher rates of HG-recurrence and disease progression. These observations reflect a potential biological distinction between the 2 entities, and highlight important implications in clinical trial design and risk stratification.