Long-term follow-up of T1 high-grade XXXX after intravesical bacille Calmette-Gu  rin treatment.

@entity1 @entity189 @entity150 @entity5
OBJECTIVE: To report the long-term results of bacille Calmette-Gu  rin (BCG) intravesical therapy in relation to disease progression and recurrence in primary T1 high-grade (HG) @entity150 ( @entity150 ) confirmed by central pathological review. @entity1 AND METHODS: In all, 136 @entity1 from two university centres (Rotterdam, n = 49; Toronto, n = 87) were diagnosed with primary T1HG @entity150 . One experienced uro-pathologist reviewed all slides, ensuring all cases were indeed HG and that muscle was present in all specimens. @entity1 were treated with BCG induction (six instillations) after transurethral resection (TUR) of the @entity5 and followed with cystoscopy and urinary cytology. Predictors for recurrence, progression and survival were assessed with multivariable Cox regression models. RESULTS: Mean (range) follow-up was 6.5 (0.3-21.6) years. There were no significant differences for recurrence (P = 0.52), progression (P = 0.35) and disease-specific survival (DSS) (P = 0.69) between the two centres. Among the cohort, 47 @entity1 (35%) recurred and 42 (30.9%) progressed with a median time to progression of 2.1 years; 16 (38%) of these progressions occurred >=  3 years after the initial BCG course; 22 (16%) @entity1 who progressed died from @entity150 . Overall, 96 (71%) @entity1 had no evidence of disease at the last follow-up. @entity189 in situ was the only independent predictor for recurrence in multivariate analysis (P = 0.011). No independent predictors were found for progression. CONCLUSIONS: Conservative treatment with BCG is a valid option in primary T1HG @entity150 . Nevertheless, the aggressive nature of T1HG @entity150 is evident in the fact that 30% progressed, with a high proportion of these progression events occurring >=  3 years after BCG. Caution should be exercised when relying on the long-term effects of BCG, and close follow-up of these @entity1 should not be neglected.
