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The natural history of bladder carcinoma in situ after initial response to bacillus Calmette-Guerin immunotherapy
Urologic Oncology: Seminars and Original Investigations, 06/29/09

Gofrit ON et al. - In a trial to explore patterns of recurrence, muscle invasion, and disease-specific mortality in pts with bladder carcinoma in situ (CIS) who responded to an induction course with intravesical bacillus Calmette-Gúerin (BCG) immunotherapy, it was shown that pure and concomitant bladder CIS share similar biologic behavior. Muscle-invasive disease is expected in about 25% of BCG responders followed for long time periods and disease-specific mortality in 15%. Tumor recurrence, whether nonmuscle-invasive or muscle-invasive, follows a similar time table suggesting that these are not sequential but parallel and independent processes.

Methods

104 pts were diagnosed with either pure (38 pts) or concomitant (66 pts) CIS.
Pts who responded to 1 (92 pts) or 2 (12 pts) induction courses of intravesical BCG instillation were included.
Response was determined and monitored by routine periodic bladder biopsies.
Outcome of pts and effect of various prognostic parameters were assessed after a median follow-up of 75 mos.

Results

5- and 10-yr recurrence-free survival rates were 63% and 54%, respectively.
5- and 10-yr muscle-invasive-free survival rates were 79% and 77%, and 5- and 10-yr disease-specific survival rates were 90.5 and 85.8%, respectively.
Median time to recurrence, muscle invasion, and disease-specific mortality was 18, 19, and 40 mos, respectively.
Pure and concomitant CIS were associated with a similar outcome.
Recurrence of nonmuscle-invasive tumor did not increase the risk for muscle invasion or mortality.

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