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KMID : 1001020030010010052
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Journal of Urologic Oncology
2003 Volume.1 No. 1 p.52 ~ p.58
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Prognostic Factors of Prophylactic Bacillus Calmette-Guerin Intravesical Instillation Therapy for Superficial Bladder Cancer
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Ko Young-Hwii
Kim Hyoung-Jin
Park Hong-Seok
Cho Jae-Heung
Yoon Duck-Ki
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Abstract
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Purpose: At high risk superficial bladder TCC, such as recurrent, high grade, multiple, large and solid tumors, bacillus Calmette-Guerin (BCG) intravesical therapy was performed for prophylactic purpose. But there was no agreement for long-term effect of BCG and there were no known prognosis factors of BCG response. So we evaluate the outcome of intravesical BCG therapy and clinical factors that were expected to estimate the response of BCG.
Materials and Methods: We reviewed records of 65 patients with superficial bladder TCC with stage Ta and T1, who were treated with BCG intravesical therapy after TURB between September 1990 and July 2001. Among them, 12 patients (18.5%) were stage Ta, 52 patients (80%) were stage T1 and all of them were followed more then 24 months with the mean of 59.8 months. The effect of each factors for recurrence and progression of bladder TCC were evaluated by multivariate analysis (logistic regression) and Chi-square test.
Results: There were no evidence of recurrence or progression of disease at 35 patients (53.8%) among 65 patients who were taken BCG intravesical therapy. At 30 patients (46.2%), recurrence were confirmed by pathologic examination and 21 patients were treated with secondary BCG intravesical therapy after second TURB. After first and secondary BCG therapy, there were no evidence of recurrence at 53 patients (81.5%) and 49 patients (75.4%) showed complete response. At 12 patients (18.5%) disease progression were found and among them, 7 patients were died of cancer. There were no statistic difference between stage (Ta, T1), multiplicity (solitary, multiple), size of tumor ( 3cm, ＜3cm), shape of tumor (papillary, sessile) and pathologic grade for recurrence of tumor (sig＞0.05, logistic regression), but disease progression were more frequent at recurrent group than primary group (sig=0.044, odds ratio=6.594).
Conclusions: At our evaluation, estimated risk factors for response to prophylactic BCG intravesical therapy does not show statistic difference on recurrence of disease. But high progression rate of recurrent group suggests that close follow-up will be needed to patient who has recurrent superficial bladder TCC.
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KEYWORD
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Superficial bladder TCC, Bacillus Calmette-Guerin, Risk factors
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