Construction of predictive models for cancer-specific survival of patients with non-muscle invasive bladder cancer treated with bacillus Calmette-Guérin: Results from a multicenter retrospective study

Abstract

Objective: The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guérin failure classification advocated by Nieder et al. in patients with nonmuscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guérin therapy. Methods: Data from 402 patients who received intravesical bacillus Calmette-Guérin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guérin failure were analyzed for this study. Results: Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guérin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guérin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the followup. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (>70 [P 1/4 0.002]), tumor size (>3 cm [P 1/4 0.015]) and the Nieder classification (bacillus Calmette-Guérin refractory [P, 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P, 0.001). Conclusions: Patients with stage progression at the first recurrence after bacillus Calmette-Gué rin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin into three risk groups based on the number of prognostic factors in each one.