Prognostic significance of non-muscle-invasive late recurrence after intravesical bacillus Calmette-Guérin therapy in bladder cancer: a multicenter, retrospective real-world study (the Japan Urological Oncology Group).

BACKGROUND

The prognostic significance of non-muscle-invasive bladder cancer (NMIBC) recurrence after a prolonged disease-free interval following intravesical Bacillus Calmette-Guérin (BCG) therapy remains unclear. This multicenter study evaluated the impact of late recurrence after BCG therapy on oncological outcomes.

METHODS

This retrospective multicenter study used the Japan Urological Oncology Group database. Among 3226 patients treated with intravesical BCG for NMIBC, 238 with non-muscle-invasive intravesical recurrence ≥1 year after initial BCG therapy were analyzed, after excluding those with muscle-invasive recurrence at first recurrence. Patients were stratified by time to recurrence: 1-2 years and ≥ 2 years. Progression-free survival (PFS) and cancer-specific survival (CSS) were assessed using Kaplan-Meier and Cox proportional hazards analyses.

RESULTS

During a median follow-up of 72.7 months, the 5-year PFS and CSS rates were 90.8% and 91.5%, respectively. PFS did not differ significantly between the 1-2-year and ≥ 2-year recurrence groups (log-rank p = 0.300). In contrast, recurrence ≥2 years was associated with significantly worse CSS than recurrence at 1-2 years (log-rank P = .018) and was a significant predictor of worse CSS in univariate analysis (hazard ratio, 8.06; 95% confidence interval, 1.02-62.6; P = .047). Repeat BCG therapy did not significantly improve PFS or CSS in patients with recurrence ≥2 years.

CONCLUSIONS

NMIBC recurrence occurring ≥2 years after initial BCG therapy may be associated with poorer cancer-specific survival despite similar progression-free survival. Late recurrence should not automatically be considered a favorable prognostic subgroup, and careful surveillance and risk stratification are warranted.