Refining BCG-failure classifications in non-muscle-invasive bladder cancer.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Ślusarczyk Aleksander, Scilipoti Pietro, Contieri Roberto, Krajewski Wojciech, Claps Francesco, Subiela José Daniel, Mertens Laura S, Mori Keiichiro, Grobet-Jeandin Elisabeth, Velasco Jorge Caño, Tully Karl, Soria Francesco, Duran Pedro Del Olmo, Puentedura Alfonso Lafuente, Lijnen Renee A G, Longoni Mattia, Marcq Gautier, Mari Andrea, Laukhtina Ekaterina, Afferi Luca, Albisinni Simone, Gallioli Andrea, Del Giudice Francesco, Boorjian Stephen A, Briganti Alberto, Shariat Shahrokh F, Gontero Paolo, Radziszewski Piotr, Moschini Marco, Pradere Benjamin, European Association of Urology‐Young Academic Urologists (EAU‐YAU), Urothelial Carcinoma Working Group
Аннотация
PATIENTS AND METHODS: From a multicentre international cohort of 3806 BCG-treated patients, 591 who developed high-grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression-free survival (PFS) was the primary endpoint; cancer-specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing-risk models and multivariable Cox regression were used.
RESULTS: Patients with BCG-unresponsive and BCG-exposed disease showed similar PFS, CSM, and OM (all P > 0.05). When stratified into five subgroups, prognosis varied: 5-year progression rates were 29% for BCG-unresponsive, 32.5% for late relapse (between 6 and 24 months) after adequate BCG, 30% for BCG-exposed with inadequate BCG (<24 months from induction), 6.2% for BCG-resistant, and 14% for very late relapse (>24 months since last BCG) (P < 0.01). In multivariable analysis, BCG-exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33-8.84), late relapse (sHR 3.74, 95% CI 1.59-8.78), and BCG-unresponsive (sHR 2.34, 95% CI 1.00-5.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity.
CONCLUSIONS: Under IBCG definitions, BCG-unresponsive and BCG-exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG-unresponsive, and very late relapses conferring better prognosis.