ABSTRACT
Background
Many patients with recurrent high-risk non-muscle invasive bladder cancer after intravesical
bacillus calmette-guerin (BCG) face a difficult decision between radical cystectomy
(RC) or salvage intravesical therapy (IVT). We sought to determine if there is a difference
in overall survival RC and IVT after previous treatment with BCG.
Methods
We performed a retrospective cohort study of patients with Ta, T1, and Tis bladder
cancer treated with induction BCG in the SEER-Medicare dataset from 2000 to 2015.
We used a proportional hazards regression model to compare differences in survival
between patients having RC and IVT. We adjusted for confounding using a propensity
score and stratified our analysis according to timing of treatment and stage at diagnosis.
Results
We identified 3940 patients who received either IVT (79%) or RC (21%) following induction
BCG. Among patients treated within 12 months of BCG, there was no significant difference
in survival between RC and IVT (HR 0.92, 95% CI 0.81-1.04) and 17% of patients having
early IVT ultimately required RC. Among patients treated at least 12 months after
BCG, RC was associated with worse survival than IVT (HR 1.19, 95% CI 1.06-1.35) and
10% of patients having late IVT ultimately required RC.
Conclusion
Among patients with bladder cancer who required additional treatments after induction
BCG, we did not observe a difference in overall survival between IVT and RC within
12 months of starting BCG. While RC remains the gold-standard for high risk recurrent
NMIBC after BCG, bladder preservation with IVT may be appropriate for well-selected
patients.
Keywords
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Article info
Publication history
Published online: July 11, 2022
Accepted:
July 5,
2022
Received:
May 23,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
