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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.

• 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.

• 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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