Recurrence and Progression of Stage T1 Bladder Tumor after Intravesical Bacillus Calmette-Guerin(BCG) Therapy

Ha, Hyug Soo; Park, Choal Hee; Kim, Chun Il

Abstract

PURPOSE: The management of patients with superficially invasive, stage T1N0M0 bladder cancer remains controversial. While some physicians advocated early cystectomy, others believe that with initial TURB and effective intravesical BCG, local disease control can be achieved in most patients. We evaluated the outcome of stage T1 transitional cell carcinoma of the bladder treated with TURB and intravesical BCG therapy.
MATERIALS AND METHODS
We reviwed records of 109 patients with stage T1 bladder tumor who treated with BCG between February 1986 and January 1997 with respect to age, grade, interval of progression and recurrence and current status. Each course of BCG consisted of 6 weekly and subsequent 3 monthly treatments. RSEULTS: Forty five of 109 patients(41.3%) had initial grade I tumors, including 13 patients (28.9%) who had at least one or more local recurrences and 2 patients(4.4%) had disease progression. Fifty seven of 109 patients(52.3%) had grade II tumors, with local recurrence in 23 patients(40.4%) and disease progression in 4 patients(7.0%). Among remaining 7 patients (6.4%) who had grade III tumors had local recurrence in 1 patient(14.3%) and disease progression in 4 patients(57.1%). The median intervals of progression on patients with initial grade I, II and III were 20.5, 15.3 and 16.9 months, respectively. Five of 10 patients who had progressed died because of the metastasis despite salvage therapies.
CONCLUSIONS
Intravesical BCG was appropriately treated for patients with initial grade I or II stage T1 tumor because of low risk of disease progression. Patients with initial grade 3 stage T1 tumor had high risk for disease progression and BCG did not seem to decrease this risk. Therefore, grade 3 stage T1 tumor was regarded as high risk of disease progression and should be treated to more aggressive modality like invasive tumor.