Non muscle invasive bladder cancer cases initially failing to respond to bacillus Calmette-Guérin intravesical instillation therapy

Objective: Bacillus Calmette-Guérin (BCG) is used as the gold standard for prevention of recurrence after transurethral resection of bladder tumor of non muscle invasive bladder cancer. However, in some cases the outcome is not optimal. In order to assess the possible impact of different variables on outcome, the present clinical evaluation of initially failed cases was performed. Patients and Methods: A total of 68 patients treated with BCG were evaluated. All suffered recurrence. Their original urothelial carcinomas were: G1/G2/G3 = 13/41/14, and Ta/T1 = 30/38. Thirteen high-risk T1G3 cases were included. Intravesical chemotherapy pretreatment was given to 10 cases. Results: The overall progression-free survival rates at 3, 5 and 10 years were 83.3, 80.9, and 72.0% respectively, with cancer-specific survival rates of 98.3, 89.0 and 89.0%. High-risk T1G3 patients were confirmed to have higher progression rates (p = 0.03, log-rank test). Total cystectomy was performed in 5 of 13 T1G3 patients, one died during the follow-up. Additional BCG treatments were performed for 8 patients, and all of them remain alive at the present time. Conclusions: These findings indicate that the response to BCG is definitely influenced by high-risk category, so that early selection of total cystectomy may improve the prognosis with T1G3 patients. However, it was also suggested that more than 1 course of BCG is a feasible option in some cases with a tendency for a worse outcome when pretreated with anti-cancer drugs.