Background: Treatment with Bacillus Calmette-Guérin (BCG) is considered
the most effective intravesical treatment for NMIBC following complete
transurethral resection of bladder tumor (TURBT). In high-risk NMIBC, e.g.,
high grade (G3) and stage T1 tumors, BCG has been shown to reduce disease
progression, and is still the most frequently used bladder-sparing option
available. Despite its efficacy, a significant proportion of BCG treated patients
(30–40%) either relapse within the first five years after treatment or fail to
respond at all (Sylvester et al., 2002).
Aim: To investigate the BCG failure in the management of NMIBC. A five-year
experience (2013 to 2017) at The National Cancer Institute, Cairo, Egypt.
Patients and Methods: Retrospective observational cohort study including all
patients diagnosed and treated with BCG at the National Cancer Institute from
2013 to 2017. 296 patients fulfilled the inclusion criteria.
Results: Age and sex had no significant impact on the disease-free survival
(p>0.151 and p>0.460 respectively). A significant association between tumor
stage and DFS was confirmed (p<0.019). Tumor grade had the most importance
impact on the DFS (p<0.001). There was an association confirmed between the
number of tumors diagnosed by cystoscopy and DFS (p<0.001) but no
statistically significant association between the number of tumors diagnosed by
radiology and DFS (p>0.176). The same items had statistically significant
impact on the rate of BCG failure (p<0.001 for grade and tumor number by
cystoscope, p=0.03 and p=0.01 for T1 and CIS respectively). Out of the 296
eligible patients, 115 patients failed treatment accounting for 38.9%. The
patterns of failure were analyzed as follows: Relapse; 61(53.0%), Resistant;
22(19.1%), Refractory; 28(24.3%) and Intolerant; 4(3.5%).
Conclusion: Stage T1 tumors, grade 3 tumors, multiple tumors, and those
associated with carcinoma in situ were all substantially linked with BCG failure.
The significant percentage of cases in this study that did not respond to this
treatment plan shows how critical it is to review the treatment plan to increase
long-term survival.
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