TY - JOUR
T1 - Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC)
T2 - A Propensity Score Matched Analysis
AU - del Giudice, Francesco
AU - Flammia, Rocco Simone
AU - Chung, Benjamin I.
AU - Moschini, Marco
AU - Pradere, Benjamin
AU - Mari, Andrea
AU - Soria, Francesco
AU - Albisinni, Simone
AU - Krajewski, Wojciech
AU - Szydełko, Tomasz
AU - Laukhtina, Ekaterina
AU - D’Andrea, David
AU - Gallioli, Andrea
AU - Mertens, Laura S.
AU - Maggi, Martina
AU - Sciarra, Alessandro
AU - Salciccia, Stefano
AU - Ferro, Matteo
AU - Scornajenghi, Carlo Maria
AU - Asero, Vincenzo
AU - Cattarino, Susanna
AU - Angelis, Mario De
AU - Cacciamani, Giovanni E.
AU - Autorino, Riccardo
AU - Pandolfo, Savio Domenico
AU - European Association of Urology (EAU)-Young Academic Urologists (YAU) Urothelial Cancer Working Party
AU - Falagario, Ugo Giovanni
AU - D’Altilia, Nicola
AU - Mancini, Vito
AU - Chirico, Marco
AU - Cinelli, Francesco
AU - Bettocchi, Carlo
AU - Cormio, Luigi
AU - Carrieri, Giuseppe
AU - de Berardinis, Ettore
AU - Busetto, Gian Maria
N1 - Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Background: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan-Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24-77) months of follow-up were reviewed. After PSM, no differences at 5- years RFS, PFS, and CSS at both Kaplan-Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25-0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.
AB - Background: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan-Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24-77) months of follow-up were reviewed. After PSM, no differences at 5- years RFS, PFS, and CSS at both Kaplan-Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25-0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.
KW - BCG strain
KW - BCG-RIVM
KW - BCG-TICE
KW - Bladder cancer
KW - Cancer-specific survival
KW - Progression-free survival
KW - Re-TUR
KW - Recurrence-free survival
UR - http://www.scopus.com/inward/record.url?scp=85124948130&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/cancers14040887
DO - https://doi.org/10.3390/cancers14040887
M3 - Article
C2 - 35205635
SN - 2072-6694
VL - 14
JO - Cancers
JF - Cancers
IS - 4
M1 - 887
ER -