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KMID : 1001020230210010070
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Journal of Urologic Oncology
2023 Volume.21 No. 1 p.70 ~ p.78
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Bladder Preservation With Transurethral Tumor Resection and Intravesical BCG Instillation in Superficial Muscle-Invasive Bladder Cancer: A 10-Year Follow-up
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Kim Dong-Gyun
Heo Ji-Eun
Cho Kang-Su
Lee Jong-Soo
Jang Won-Sik
Cho Nam-Hoon
Choi Young-Deuk
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Abstract
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Purpose: The aim of this study was to evaluate the 10-year oncological outcomes of bladder preservation with transurethral resection of bladder tumor (TURBT) and intravesical bacillus Calmette-Guerin (BCG) instillation in selected patients with superficial muscle-invasive bladder cancer (MIBC).
Materials and Methods: Patients diagnosed with superficial MIBC (stage T2a) by TURBT between 2001 and 2009 were included. Cystectomy-free survival, recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify predictors of each type of survival.
Results: Of 145 patients, 135 underwent bladder preservation and 10 underwent immediate radical cystectomy (RC). Among the latter, 9 patients showed downstaging. During a median follow-up of 132 months (interquartile range, 96?161 months), 13 patients underwent RC, with a 10-year cystectomy-free survival rate of 83.9%.
Seventy patients (48.3%) had recurrence, and the 10-year RFS rate was 48.9%. Progression occurred in 12 patients (8.3%), with a 10-year PFS rate of 90.1%. Death occurred only in patients who exhibited progression; 5 patients (3.4%) died of bladder cancer, and the 10-year CSS rate was 96.5%. Tumors greater than 3 cm were associated with RC, and a high tumor grade predicted recurrence. RC was related to progression and cancerspecific mortality.
Conclusions: Although high-grade tumors require careful follow-up, bladder preservation with TURBT and intravesical BCG instillation can enable the successful management of selected patients with stage T2a MIBC less than 3 cm, without carcinoma in situ or tumor-associated hydronephrosis, in a nonmetastatic setting.
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KEYWORD
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BCG vaccine, Organ preservation, Survival, Transurethral resection of bladder, Urinary bladder neoplasms
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