Background

Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) is a newly defined subtype that is unlikely to benefit from BCG rechallenge. Radical cystectomy is currently recommended for BCG-unresponsive NMIBC; however, a certain proportion of these patients can be managed with treatments other than that. Herein, we conducted a multicenter retrospective study to analyze the clinical outcomes of BCG-unresponsive NMIBC patients who did not receive radical cystectomy.

Methods

Of the 141 BCG-unresponsive NMIBC patients, 94 (66.7%) received treatment except radical cystectomy. Survival outcomes were calculated from the date of diagnosis using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors were identified using the multivariate Cox regression model. This group was further classified into three groups according to the number of risk factors, and survival outcomes were compared.

Results

Multivariate analyses identified low estimated glomerular filtration rate (< 45 ml/min/1.73 m²) and large tumor size (≥ 30 mm) before BCG induction as independent poor prognostic factors for progression-free survival and overall survival, while the latter was also an independent factor for cancer-specific survival. The presence of variant histology was an independent poor prognostic factor for overall survival. The high-risk non-cystectomy group showed a significantly poor prognosis for progression-free survival (hazard ratio: 7.61, 95% confidence interval: 2.11–27.5), cancer-specific survival (10.4, 0.54–70.02), and overall survival (8.28, 1.82–37.7).

Conclusions

Our findings suggest that patients with renal impairment and large tumors should undergo radical cystectomy if the complications and intentions of the patients allow so.

中文翻译：

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未进行根治性膀胱切除术的患者中卡介苗无反应性非肌层浸润性膀胱癌结果

背景

卡介苗 (BCG)-无反应性非肌肉浸润性膀胱癌 (NMIBC) 是一种新定义的亚型，不太可能从 BCG 再激发中获益。目前推荐对 BCG 无反应的 NMIBC 进行根治性膀胱切除术；然而，这些患者中有一定比例可以通过除此之外的治疗进行管理。在此，我们进行了一项多中心回顾性研究，以分析未接受根治性膀胱切除术的 BCG 无反应 NMIBC 患者的临床结果。

方法

在 141 名 BCG 无反应的 NMIBC 患者中，94 名（66.7%）接受了除根治性膀胱切除术以外的治疗。使用 Kaplan-Meier 方法从诊断日期开始计算生存结果，并使用对数秩检验进行比较。使用多变量 Cox 回归模型确定预后因素。根据危险因素的数量将该组进一步分为三组，并比较生存结果。

结果

多变量分析将BCG 诱导前的低估计肾小球滤过率 (< 45 ml/min/1.73 m ² ) 和大肿瘤尺寸 (≥ 30 mm) 确定为无进展生存期和总生存期的独立不良预后因素，而后者也是癌症特异性生存的独立因素。变异组织学的存在是总生存期的一个独立的不良预后因素。高风险非膀胱切除术组在无进展生存期（风险比：7.61，95% 置信区间：2.11-27.5）、癌症特异性生存期（10.4，0.54-70.02）和总生存期（ 8.28, 1.82–37.7)。

结论

我们的研究结果表明，如果患者的并发症和意图允许，肾功能不全和大肿瘤的患者应该接受根治性膀胱切除术。