Actas urologicas espanolas · 1999
[Progression and prognosis of in situ carcinoma of the bladder treated with BCG].
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Arrizabalaga Moreno M, García González J I, Esteban Artiaga R, Castro Pita M, Navarro Sebastián J, Mora Durbán M, Paniagua Andrés P
Аннотация
OBJECTIVES: In situ carcinoma (isT) of the bladder is a poor prognostic tumour with a natural progressive evolution. Treatment with BCG achieves a significant improvement in survival. This paper analyses our experience in the management of isT patients with endovesical BCG.
MATERIAL AND METHODS: Between 1983 and 1997 the Urology Unit in the Móstoles Hospital saw 636 patients with transitional carcinoma of the bladder. Of these, 498 (78%) were surface tumours, and 138 (22%) were infiltrant. isT: 80 patients (13%), 14 of which were primary (17%), 37 associated to a surface tumour (46%), and 29 to infiltrant tumours (36%). All surface tumours: isT was present in 51 patients (10%) 44 of which were managed with 2 courses of BCG Connaught (81 mg), for 6 weeks each followed by vesical reassessment. Quarterly follow-up was conducted during a 2-year period. Patients not managed with BCG were treated with radical cystectomy. An analysis was made of patients without complete response to BCG, as well as actuarial analysis of disease-free survival (DFS), survival until progression (SUP) and specific survival (SS). All possible prognostic factors are analyzed: sex, focal isT (a single focus) or diffuse isT (more than one focus). Primary or secondary isT and association to G1, G2 or G3 tumours.
RESULTS: In all 44 patients managed with BCG: males 37 (84%), females 7 (16%), primary 14 (32%), focal 22 (50%), diffuse 22 (50%). Six patients died (5 because of the tumour). Mean follow-up of living patients: 3.7 years (0.5-7.5 years). After the 2 BCG courses, 36 (82%) showed complete response. Thirteen patients (30%) had no complete response during follow-up, and 11 (85%) continued to progression. In total 7 patients underwent cystectomy. Of 5 patients directly cystectomized due to persistence of isT or T1G3 tumour at monitoring after BCG, 2 (40%) had infiltrant tumour and one (20%) nodular metastasis. Three patients with persistent isT or T1G3 after BCG were not initially cystectomized: two that were treated with other endovesical therapies because of their age progressed, and the third one underwent a third BCG course and required cystectomy due to tumour persistency. 5-year DFS: 56%, being diffuse isT vs. focal isT (p = 0.0206) was an unfavourable prognostic factor. 5-year SUP: 63%, no significant prognostic factor. 5-year SS: 79%, being a female was an unfavourable prognostic factor (p = 0.0201).
CONCLUSIONS: Based on our results and the analysis of the literature we recommend treatment with 2 BCG courses of all isTs of the bladder that present some of the following factors: Diffuse cancer associated to T1G3, involvement of prostatic urethra or overexpression of p53 over 20%. In the rest of vesical tumours, one BCG course followed by a second one if lack of response to the first. After failure of both BCG courses, cystectomy must be performed in both groups.
MATERIAL AND METHODS: Between 1983 and 1997 the Urology Unit in the Móstoles Hospital saw 636 patients with transitional carcinoma of the bladder. Of these, 498 (78%) were surface tumours, and 138 (22%) were infiltrant. isT: 80 patients (13%), 14 of which were primary (17%), 37 associated to a surface tumour (46%), and 29 to infiltrant tumours (36%). All surface tumours: isT was present in 51 patients (10%) 44 of which were managed with 2 courses of BCG Connaught (81 mg), for 6 weeks each followed by vesical reassessment. Quarterly follow-up was conducted during a 2-year period. Patients not managed with BCG were treated with radical cystectomy. An analysis was made of patients without complete response to BCG, as well as actuarial analysis of disease-free survival (DFS), survival until progression (SUP) and specific survival (SS). All possible prognostic factors are analyzed: sex, focal isT (a single focus) or diffuse isT (more than one focus). Primary or secondary isT and association to G1, G2 or G3 tumours.
RESULTS: In all 44 patients managed with BCG: males 37 (84%), females 7 (16%), primary 14 (32%), focal 22 (50%), diffuse 22 (50%). Six patients died (5 because of the tumour). Mean follow-up of living patients: 3.7 years (0.5-7.5 years). After the 2 BCG courses, 36 (82%) showed complete response. Thirteen patients (30%) had no complete response during follow-up, and 11 (85%) continued to progression. In total 7 patients underwent cystectomy. Of 5 patients directly cystectomized due to persistence of isT or T1G3 tumour at monitoring after BCG, 2 (40%) had infiltrant tumour and one (20%) nodular metastasis. Three patients with persistent isT or T1G3 after BCG were not initially cystectomized: two that were treated with other endovesical therapies because of their age progressed, and the third one underwent a third BCG course and required cystectomy due to tumour persistency. 5-year DFS: 56%, being diffuse isT vs. focal isT (p = 0.0206) was an unfavourable prognostic factor. 5-year SUP: 63%, no significant prognostic factor. 5-year SS: 79%, being a female was an unfavourable prognostic factor (p = 0.0201).
CONCLUSIONS: Based on our results and the analysis of the literature we recommend treatment with 2 BCG courses of all isTs of the bladder that present some of the following factors: Diffuse cancer associated to T1G3, involvement of prostatic urethra or overexpression of p53 over 20%. In the rest of vesical tumours, one BCG course followed by a second one if lack of response to the first. After failure of both BCG courses, cystectomy must be performed in both groups.