MP43-04 CONTEMPORARY OUTCOMES OF NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS TREATED WITH INDUCTION BCG

Abstract

INTRODUCTION AND OBJECTIVES: Intravesical BCG remains standard therapy for non-muscle invasive bladder cancer (NMIBC) despite a historical relapse rate of 30-40%. We present the clinical characteristics and natural history from a contemporary cohort who completed induction BCG for NMIBC in an effort to identify predictors of clinical outcomes to aid treatment decisions. METHODS: NMIBC patients treated with induction BCG at our institution between 2000 and 2015 were retrospectively identified. Only patients receiving full 6 instillation induction therapy were included. Cystoscopy was performed at standard intervals to assess response to therapy. All treatment decisions regarding additional BCG treatment (reinduction or maintenance) or definitive therapy (i.e. radical cystectomy [RC]) were made by the treating urologist. Clinical outcomes were recurrence free survival (RFS), cystectomy free survival (CFS), progressions free survival (PFS), and cancer specific survival (CSS). Statistical methods included Kaplan-Meier survival analysis and Cox proportional hazards modelling. RESULTS: Final analysis included 422 patients with 42.3 months median follow-up. At baseline, 80.6% were male and 35.1% never-smokers. The cohort was comprised of mostly HG (87.4%) and multifocal (60.4%) disease distributed between T1 (49.5%), Ta (45.7%), and CIS alone (4.8%). Only 6.2% of patients received prior BCG therapy. At least 1 full cycle of maintenance BCG was administered in 90% of the cohort. Disease recurred in 41.5% (175/422) and 15.6% (66/422) proceeded to RC. Progression (MIBC or metastasis) occurred in 10.2% (43/422) and 5.2% (22/422) died of disease. The 5-year RFS, CFS, PFS, and CSS were 59%, 83%, 88%, and 92%, respectively. On multivariate analysis (Table) worse RFS was significantly associated with T1 tumors, multifocality, and prior BCG. Having any HG recurrences predicted worse CFS, PFS, and CSS. Notably, there was no difference in CSS whether or not RC was performed. CONCLUSIONS: In a contemporary cohort of NMIBC patients who received a complete course of BCG induction, we found that while recurrence is common, a substantial portion will be able to retain their bladders without negative impact on survival. Repeated therapy with BCG appears to be the strongest indicator of worse clinical outcomes, suggesting these patients might require consideration for other treatment options. (Table Presented).