| Abstrakt: |
Introduction and Objectives. To evaluate long-term overall survival and predictive factors after TURBT and adjuvant intravesical Bacillus Calmette-Guérin (BCG) treatment, in patients with T1 bladder cancer. Materials and Methods. We retrospectively analyzed, 53 patients who underwent transurethral resection of bladder tumor (TURBT) for intermediate and high-grade T1 non-muscle invasive bladder cancer (NMIBC) followed by BCG instillations at our clinic between 2006 and 2008. Primary end-point was overall survival (OS). Data about survival were obtained from the National insurance registry. Survival analysis was performed using the Kaplan Meyer method, and the log-rank test was used for univariate comparisons. Univariable and multivariable Cox regression models addressed the association of prognostic factors with OS. Results. Median follow-up was 79 months (IQR 58-110 months), 33 (62.3%) patients died. In our study, males were 43 (81.13%) and females 10 (18.86%), 41 (77.35%) patients had tumors over 3 cm in diameter, 37 (69.81%) with multiple tumors at diagnosis and 43 (81.13%) patients with high risk tumors (G3). In univariable analysis, clinico-pathologic factors such as age (p=0.003) and recurrence of tumors (p=0.005) were associated with worse OS. In multivariable analysis, independent predictors of OS were gender (HR1.06, 95% CI 1.02-1.11, p=0.002), multifocality (HR 3.03, 95% CI 1.15-7.92, p=0.024) and tumor grade (HR3.59, 95% CI 1.23-10.14, p=0.019). Progression rate was 11.3%%. Recurrence rate was 30.2%. Five year overall survival was 72.2% (95%CI: 58.2-82.2) and at 10-yr 37% (95%CI: 24.4-49.6). Limitations include retrospective design, mono-center study and small sample size. Conclusions. Our study supports current evidence that BCG therapy with maintenance is an effective and safe therapy for T1 bladder cancer patients and it is a viable option for long-term use in such patients. We found that age and recurrence of tumors were associated with poor overall survival. Elderly patients should be strictly monitored and in recurrence patients alternative options may be offered. [ABSTRACT FROM AUTHOR] |
