Skip to main content

Advertisement

SpringerLink
Log in

Analysis of age influence on oncological results and toxicity of BCG immunotherapy in non-muscle invasive bladder cancer

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to analyse the influence of age on the treatment outcome and toxicity in patients with T1HG non-muscle invasive bladder cancers treated with BCG immunotherapy.

Methods

Data from 637 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in two academic centres were retrospectively reviewed. Median follow-up was 57 months. Patients were divided into two groups: younger (< 70 years old) and older (≥ 70 years old). Additional analyses in subgroups of older (> 75 and > 80) patients were performed. Log-rank test, Cox regression analysis, and propensity score matching were performed to compare the groups.

Results

There were 389 patients below and 248 patients above or equal 70 years old. Recurrence-free, progression-free, and cancer-specific survival rates did not differ significantly between younger and older patients. Recurrence-free survival for younger and older patients were 55.4% vs 52.9%, progression-free survival 75.9% vs 76.6%, and cancer-specific survival were 87.5% vs 89.9% (all p > 0.05). Differences in the oldest subgroups also did not reach statistical significance. In both regression analysis and propensity score matching, no statistically significant associations of age with any of analysed end-points were found. Finally, there were no statistically significant differences between younger and older group in terms of moderate and severe complications occurrence (47.6% vs. 44.5%; p > 0.05)

Conclusions

It was shown that increasing age was not associated with BCG immunotherapy oncological outcomes, or with BCG toxicity in T1HG non-muscle invasive bladder cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data are available for bona fide researchers who request it from the authors. Wojciech Krajewski had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References

  1. Babjuk M, Bohle A, Burger M et al (2017) eau guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461. https://doi.org/10.1016/j.eururo.2016.05.041

    Article  PubMed  Google Scholar 

  2. Shintani Y, Sawada Y, Inagaki T et al (2007) Intravesical instillation therapy with bacillus Calmette–Guerin for superficial bladder cancer: study of the mechanism of bacillus Calmette–Guerin immunotherapy. Int J Urol 14:140–146. https://doi.org/10.1111/j.1442-2042.2007.01696.x

    Article  CAS  PubMed  Google Scholar 

  3. DeVeale B, Brummel T, Seroude L (2004) Immunity and aging: the enemy within? Aging Cell 3:195–208. https://doi.org/10.1111/j.1474-9728.2004.00106.x

    Article  CAS  PubMed  Google Scholar 

  4. Pfister G, Savino W (2008) Can the immune system still be efficient in the elderly? An immunological and immunoendocrine therapeutic perspective. NeuroImmunoModulation 15:351–364. https://doi.org/10.1159/000156477

    Article  CAS  PubMed  Google Scholar 

  5. Herr HW (2007) Age and outcome of superficial bladder cancer treated with bacille Calmette–Guerin therapy. Urology 70:65–68. https://doi.org/10.1016/j.urology.2007.03.024

    Article  PubMed  Google Scholar 

  6. Margel D, Alkhateeb SS, Finelli A et al (2011) Diminished efficacy of bacille Calmette–Guerin among elderly patients with nonmuscle invasive bladder cancer. Urology 78:848–854. https://doi.org/10.1016/j.urology.2011.04.070

    Article  PubMed  Google Scholar 

  7. Yuge K, Kikuchi E, Matsumoto K et al (2011) Could patient age influence tumor recurrence rate in non-muscle-invasive bladder cancer patients treated with BCG immunotherapy? Jpn J Clin Oncol 41:565–570. https://doi.org/10.1093/jjco/hyq241

    Article  PubMed  Google Scholar 

  8. Calo B, Sanguedolce F, Fortunato F et al (2019) The impact of age on intravesical instillation of bacille Calmette–Guerin treatment in patients with high-grade T1 bladder cancer. Medicine (Baltimore) 98:e16223. https://doi.org/10.1097/MD.0000000000016223

    Article  CAS  PubMed Central  Google Scholar 

  9. Oddens JR, Sylvester RJ, Brausi MA et al (2014) The effect of age on the efficacy of maintenance bacillus Calmette–Guerin relative to maintenance epirubicin in patients with stage Ta T1 urothelial bladder cancer: results from EORTC genito-urinary group study 30911. Eur Urol 66:694–701. https://doi.org/10.1016/j.eururo.2014.05.033

    Article  CAS  PubMed  Google Scholar 

  10. Sjolander A (2009) Propensity scores and M-structures. Stat Med 28:1416–1420. https://doi.org/10.1002/sim.3532 (author reply 1420–1413)

    Article  PubMed  Google Scholar 

  11. Team RC (2017) A language and environment for statistical computing Vienna, Austria2017 [cited 2017 21.08.2017]. https://www.R-project.org. Accessed July 2019

  12. Sylvester RJ, van der Meijden AP, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:465–466. https://doi.org/10.1016/j.eururo.2005.12.031(discussion 475–467)

    Article  Google Scholar 

  13. Fernandez-Gomez J, Madero R, Solsona E et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette–Guerin: the CUETO scoring model. J Urol 182:2195–2203. https://doi.org/10.1016/j.juro.2009.07.016

    Article  PubMed  Google Scholar 

  14. Joudi FN, Smith BJ, O'Donnell MA et al (2006) The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy. J Urol 175:1634–1639. https://doi.org/10.1016/S0022-5347(05)00973-0 (discussion 1639–1640)

    Article  PubMed  Google Scholar 

  15. Heiner JG, Terris MK (2008) Effect of advanced age on the development of complications from intravesical bacillus Calmette–Guerin therapy. Urol Oncol 26:137–140. https://doi.org/10.1016/j.urolonc.2007.04.005

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland

    Wojciech Krajewski, Romuald Zdrojowy & Anna Kołodziej

  2. Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain

    Oscar Rodríguez Faba, Alberto Breda, Francesca Pisano & Juan Palou

  3. Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland

    Sławomir Poletajew

  4. Social Medicine Department, Wrocław Medical University, Wrocław, Poland

    Andrzej Tukiendorf

Authors
  1. Wojciech Krajewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oscar Rodríguez Faba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Breda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Pisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sławomir Poletajew
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrzej Tukiendorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Romuald Zdrojowy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna Kołodziej
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juan Palou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WK: manuscript writing and project development. OR-F: manuscript editing and project development. AB: data management and manuscript writing. FP: data collection and manuscript writing. SP: data collection and manuscript writing. AT: data analysis and manuscript writing. RZ: data analysis and manuscript writing. AK: data analysis and manuscript writing. JP: data analysis and manuscript writing.

Corresponding author

Correspondence to Oscar Rodríguez Faba.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This is retrospective observation. Informed consent was obtained from all individual participants at the time of their BCG therapy onset, stating that in future, their data may be included in the scientific studies.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krajewski, W., Rodríguez Faba, O., Breda, A. et al. Analysis of age influence on oncological results and toxicity of BCG immunotherapy in non-muscle invasive bladder cancer. World J Urol 38, 3177–3182 (2020). https://doi.org/10.1007/s00345-020-03130-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03130-1

Keywords

Search

Navigation