BJU international · 2025
Long-term outcomes of a cascading salvage strategy for high-risk non-muscle-invasive bladder cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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McElree Ian M, Steinberg Ryan L, Hougen Helen Y, Mott Sarah L, Packiam Vignesh T, O'Donnell Michael A
Аннотация
OBJECTIVE: To report long-term oncological outcomes of patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) undergoing bladder-sparing therapy (BST) after bacillus Calmette-Guérin (BCG) failure.
PATIENTS AND METHODS: We retrospectively reviewed patients with HR-NMIBC treated from 2000 to 2025 with intravesical therapies after BCG failure, all of whom received salvage gemcitabine/docetaxel (Gem/Doce). Subsequent BST included valrubicin/docetaxel, sequential doxorubicin/gemcitabine alternating with mitomycin-C/docetaxel, and gemcitabine/cabazitaxel with pembrolizumab. Kaplan-Meier analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), cystectomy-free survival (CFS), and cancer-specific survival (CSS).
RESULTS: A total of 85 patients with HR-NMIBC were included of whom 38 (45%) were BCG-unresponsive. The median (interquartile range) follow-up was 86 (43-108) months from induction Gem/Doce. Following Gem/Doce initiation, RFS did not significantly decline with each successive line of salvage therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2-year RFS was 47%, 43%, and 39%, respectively (P = 0.68). Overall, the PFS at 5 years was 81% (95% confidence interval [CI] 69-88%). PFS did not significantly decline with each successive salvage line of therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2-year PFS was 91%, 88%, and 93%, respectively (P = 0.98). CFS and CSS were 74% (95% CI 62-83%) and 88% (95% CI 79-94%) at 5 years, respectively.
CONCLUSIONS: Multi-line BST is feasible and can yield durable bladder preservation and oncological control in select patients with HR-NMIBC following BCG failure. Progression-free outcomes remained favourable across successive lines of salvage therapy. These findings support the role of longitudinal BST as an alternative to radical cystectomy in carefully and appropriately selected patients.
PATIENTS AND METHODS: We retrospectively reviewed patients with HR-NMIBC treated from 2000 to 2025 with intravesical therapies after BCG failure, all of whom received salvage gemcitabine/docetaxel (Gem/Doce). Subsequent BST included valrubicin/docetaxel, sequential doxorubicin/gemcitabine alternating with mitomycin-C/docetaxel, and gemcitabine/cabazitaxel with pembrolizumab. Kaplan-Meier analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), cystectomy-free survival (CFS), and cancer-specific survival (CSS).
RESULTS: A total of 85 patients with HR-NMIBC were included of whom 38 (45%) were BCG-unresponsive. The median (interquartile range) follow-up was 86 (43-108) months from induction Gem/Doce. Following Gem/Doce initiation, RFS did not significantly decline with each successive line of salvage therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2-year RFS was 47%, 43%, and 39%, respectively (P = 0.68). Overall, the PFS at 5 years was 81% (95% confidence interval [CI] 69-88%). PFS did not significantly decline with each successive salvage line of therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2-year PFS was 91%, 88%, and 93%, respectively (P = 0.98). CFS and CSS were 74% (95% CI 62-83%) and 88% (95% CI 79-94%) at 5 years, respectively.
CONCLUSIONS: Multi-line BST is feasible and can yield durable bladder preservation and oncological control in select patients with HR-NMIBC following BCG failure. Progression-free outcomes remained favourable across successive lines of salvage therapy. These findings support the role of longitudinal BST as an alternative to radical cystectomy in carefully and appropriately selected patients.