Bacille Calmette Guérin (BCG) Failure in Non-muscle Invasive Bladder Cancer. An Egyptian Tertiary Center Experience | ||||
| SECI Oncology Journal | ||||
| Volume 13, Issue 2, April 2025, Page 164-171 PDF (391.43 K) | ||||
| DOI: 10.21608/secioj.2025.431510 | ||||
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| Abstract | ||||
| 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. | ||||
| Keywords | ||||
| Non muscle invasive bladder cancer (NMIBC); Bacillus Calmette Guerin (BCG); Bladder cancer; BCG failure | ||||
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