Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with non-muscle invasive bladder cancer? An update and cumulative meta-analysis
Jiangang Pan, Mo Liu, Xing Zhou
Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with non-muscle invasive bladder cancer? An update and cumulative meta-analysis
Approximately 70% of newly diagnosed bladder tumors are non-muscle invasive bladder cancer (NMIBC). NMIBC accounts for approximately 80% of total bladder cancer cases. Bacillus Calmette-Guérin (BCG) instillation and maintenance is considered as the standard adjuvant treatment for superficial bladder cancer. A number of randomized studies have focused on the benefit of maintenance therapy following initial BCG induction. To provide further insights into the effect of intravesical instillation on recurrence in patients with NMIBC, we analyzed this relationship by conducting an updated detailed meta-analysis. Evidence suggested that adjuvant intravesical BCG with maintenance treatment is significantly effective for the prophylaxis of tumor recurrence in patients with NMIBC.
non-muscle invasive bladder cancer / bacillus Calmette-Guérin (BCG) / meta-analysis
[1] |
FabaOR, PalouJ, BredaA, VillavicencioH. High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment. World J Urol2012; 30(6): 833–840
CrossRef
Pubmed
Google scholar
|
[2] |
AldousariS, KassoufW. Update on the management of non-muscle invasive bladder cancer. Can Urol Assoc J2010; 4(1): 56–64
Pubmed
|
[3] |
BrausiM, WitjesJA, LammD, PersadR, PalouJ, ColombelM, BuckleyR, SolowayM, AkazaH, BöhleA. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol2011; 186(6): 2158–2167
CrossRef
Pubmed
Google scholar
|
[4] |
LammDL, BlumensteinBA, CrissmanJD, MontieJE, GottesmanJE, LoweBA, SarosdyMF, BohlRD, GrossmanHB, BeckTM, LeimertJT, CrawfordED. Maintenance bacillus Calmette-Guérin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol2000; 163(4): 1124–1129
CrossRef
Pubmed
Google scholar
|
[5] |
KulkarniGS, HakenbergOW, GschwendJE, ThalmannG, KassoufW, KamatA, ZlottaA. An updated critical analysis of the treatment strategy for newly diagnosed high-grade T1 (previously T1G3) bladder cancer. Eur Urol2010; 57(1): 60–70
Pubmed
|
[6] |
MoralesA, EidingerD, BruceAW. Intracavitary Bacillus Calmette-Guérin in the treatment of superficial bladder tumors. J Urol1976; 116(2): 180–183
Pubmed
|
[7] |
BabjukM, OosterlinckW, SylvesterR, KaasinenE, BöhleA, Palou-RedortaJ, RouprêtM; European Association of Urology (EAU). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol2011; 59(6): 997–1008PMID:21458150
CrossRef
Google scholar
|
[8] |
ShelleyMD, MasonMD, KynastonH. Intravesical therapy for superficial bladder cancer: a systematic review of randomised trials and meta-analyses. Cancer Treat Rev2010; 36(3): 195–205
CrossRef
Pubmed
Google scholar
|
[9] |
HanRF, PanJG. Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials. Urology2006; 67(6): 1216–1223
CrossRef
Pubmed
Google scholar
|
[10] |
YooKH, LimTJ, ChangSG. Monthly intravesical bacillus Calmette-Guérin maintenance therapy for non-muscle-invasive bladder cancer: 10-year experience in a single institute. Exp Ther Med2012; 3(2): 221–225
Pubmed
|
[11] |
GülpinarÖ, HaliliogluAH, GökçeMI, GöğüşÇ, BaltaciS. The value of perioperative mitomycin C instillation in improving subsequent bacillus Calmette-Guérin instillation efficacy in intermediate and high-risk patients with non-muscle invasive bladder cancer: a prospective randomized study. Int Braz J Urol2012; 38(4): 474–479
Pubmed
|
[12] |
MatsumotoK, KikuchiE, ShirakawaH, HayakawaN, TanakaN, NinomiyaA, MiyajimaA, NakamuraS, OyaM. Risk of subsequent tumour recurrence and stage progression in bacille Calmette-Guérin relapsing non-muscle-invasive bladder cancer. BJU Int2012; 110(11b): E508–E513
CrossRef
Pubmed
Google scholar
|
[13] |
ChoIC, KimEK, JoungJY, SeoHK, ChungJ, ParkWS, LeeKH. Adjuvant intravesical instillation for primary T1G3 bladder cancer: BCG versus MMC in Korea. Anticancer Res2012; 32(4): 1493–1498
Pubmed
|
[14] |
OkamuraT, AkitaH, AndoR, IkegamiY, NaikiT, KawaiN, TozawaK, KohriK. Single monthly bacillus Calmette-Guérin intravesical instillation is effective maintenance therapy to prevent recurrence in Japanese patients with non-muscle-invasive bladder cancer. Int J Clin Oncol2012; 17(5): 477–481
CrossRef
Pubmed
Google scholar
|
[15] |
ChenCH, YangHJ, ShunCT, HuangCY, HuangKH, YuHJ, PuYS. A cocktail regimen of intravesical mitomycin-C, doxorubicin, and cisplatin (MDP) for non-muscle-invasive bladder cancer. Urol Oncol2012; 30(4): 421–427
Pubmed
|
[16] |
HinotsuS, AkazaH, NaitoS, OzonoS, SumiyoshiY, NoguchiS, YamaguchiA, NagamoriS, TeraiA, NasuY, KumeH, TomitaY, TanakaY, SammaS, UemuraH, KogaH, TsushimaT. Maintenance therapy with bacillus Calmette-Guérin Connaught strain clearly prolongs recurrence-free survival following transurethral resection of bladder tumour for non-muscle-invasive bladder cancer. BJU Int2011; 108(2): 187–195
CrossRef
Pubmed
Google scholar
|
[17] |
OosterlinckW, KirkaliZ, SylvesterR, da SilvaFC, BuschC, AlgabaF, ColletteS, BonoA. Sequential intravesical chemoimmunotherapy with mitomycin C and bacillus Calmette-Guérin and with bacillus Calmette-Guérin alone in patients with carcinoma in situ of the urinary bladder: results of an EORTC genito-urinary group randomized phase 2 trial (30993). Eur Urol2011; 59(3): 438–446
Pubmed
|
[18] |
KogaH, OzonoS, TsushimaT, TomitaK, HoriguchiY, UsamiM, HiraoY, AkazaH, NaitoS; BCG Tokyo Strain Study Group. Maintenance intravesical bacillus Calmette-Guérin instillation for Ta, T1 cancer and carcinoma in situ of the bladder: randomized controlled trial by the BCG Tokyo Strain Study Group. Int J Urol2010; 17(9): 759–766
CrossRef
Google scholar
|
[19] |
PorenaM, Del ZingaroM, LazzeriM, MeariniL, GiannantoniA, BiniV, CostantiniE. Bacillus Calmette-Guérin versus gemcitabine for intravesical therapy in high-risk superficial bladder cancer: a randomised prospective study. Urol Int2010; 84(1): 23–27
CrossRef
Pubmed
Google scholar
|
[20] |
Di LorenzoG, PerdonàS, DamianoR, FaiellaA, CantielloF, PignataS, AsciertoP, SimeoneE, De SioM, AutorinoR. Gemcitabine versus bacille Calmette-Guérin after initial bacille Calmette-Guérin failure in non-muscle-invasive bladder cancer: a multicenter prospective randomized trial. Cancer2010; 116(8): 1893–1900
CrossRef
Pubmed
Google scholar
|
[21] |
ChoDY, BaeJH, MoonDG, CheonJ, LeeJG, KimJJ, YoonDK, ParkHS. The effects of intravesical chemoimmunotherapy with gemcitabine and Bacillus Calmette-Guérin in superficial bladder cancer: a preliminary study. J Int Med Res2009; 37(6): 1823–1830
CrossRef
Pubmed
Google scholar
|
[22] |
SylvesterRJ, BrausiMA, KirkelsWJ, HoeltlW, Calais Da SilvaF, PowellPH, PrescottS, KirkaliZ, van de BeekC, GorliaT, de ReijkeTM; EORTC Genito-Urinary Tract Cancer Group. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol2010; 57(5): 766–773
CrossRef
Pubmed
Google scholar
|
[23] |
DuchekM, JohanssonR, JahnsonS, MestadO, HellströmP, HellstenS, MalmströmPU; Members of the Urothelial Cancer Group of the Nordic Association of Urology. Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study. Eur Urol2010; 57(1): 25–31
Pubmed
|
[24] |
JärvinenR, KaasinenE, SankilaA, RintalaE; FinnBladder Group. Long-term efficacy of maintenance bacillus Calmette-Guérin versus maintenance mitomycin C instillation therapy in frequently recurrent TaT1 tumours without carcinoma in situ: a subgroup analysis of the prospective, randomised FinnBladder I study with a 20-year follow-up. Eur Urol2009; 56(2): 260–265
Pubmed
|
[25] |
YiSH, YeG, WangXW, JinHS, ZhangYN, YanZL. Prophylactic effect of inductive intravesical instillation of Bacillus Calmette-Guérin on postoperative recurrence of bladder cancer. Chin J Cancer (Ai Zheng)2008; 27(11): 1208–1211 (in Chinese)
Pubmed
|
[26] |
CaiT, NesiG, TinacciG, ZiniE, MondainiN, BoddiV, MazzoliS, BartolettiR. Can early single dose instillation of epirubicin improve bacillus Calmette-Guérin efficacy in patients with nonmuscle invasive high risk bladder cancer? Results from a prospective, randomized, double-blind controlled study. J Urol2008; 180(1): 110–115
Pubmed
|
[27] |
OjeaA, NogueiraJL, SolsonaE, FloresN, GómezJM, MolinaJR, ChantadaV, CamachoJE, PiñeiroLM, RodríguezRH, IsornaS, BlasM, Martínez-PiñeiroJA, MaderoR; CUETO Group (Club Urológico Español De Tratamiento Oncológico). A multicentre, randomised prospective trial comparing three intravesical adjuvant therapies for intermediate-risk superficial bladder cancer: low-dose bacillus Calmette-Guérin (27 mg) versus very low-dose bacillus Calmette-Guérin (13.5 mg) versus mitomycin C. Eur Urol2007; 52(5): 1398–1406
CrossRef
Pubmed
Google scholar
|
[28] |
FriedrichMG, PichlmeierU, SchwaiboldH, ConradS, HulandH. Long-term intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term intravesical chemotherapy and short-term therapy with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma. Eur Urol2007; 52(4): 1123–1130
CrossRef
Pubmed
Google scholar
|
[29] |
HinotsuS, AkazaH, IsakaS, KanetakeH, KubotaY, KurodaM, ShinoharaN, ShinkaT, TachibanaM, NaitoS, HiraoY; BCG Tokyo 172 Strain Study Group. Sustained prophylactic effect of intravesical bacille Calmette-Guérin for superficial bladder cancer: a smoothed hazard analysis in a randomized prospective study. Urology2006; 67(3): 545–549
CrossRef
Pubmed
Google scholar
|
[30] |
Di StasiSM, GiannantoniA, GiurioliA, ValentiM, ZampaG, StortiL, AttisaniF, De CarolisA, CapelliG, VespasianiG, StephenRL. Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomised controlled trial. Lancet Oncol2006; 7(1): 43–51
CrossRef
Pubmed
Google scholar
|
[31] |
StartsevV, PoulineI. Adjuvant therapy in different risk-groups of patients with superficial bladder cancer. Arch Ital Urol Androl2005; 77(2): 93–98
Pubmed
|
[32] |
ChengCW, ChanSF, ChanLW, ChanCK, NgCF, CheungHY, ChanSY, WongWS, LaiFM, ToKF, LiML. Twelve-year follow up of a randomized prospective trial comparing bacillus Calmette-Guérin and epirubicin as adjuvant therapy in superficial bladder cancer. Int J Urol2005; 12(5): 449–455
CrossRef
Pubmed
Google scholar
|
[33] |
KulkarniJN, GuptaR. Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette-Guérin (Danish 1331 strain). BJU Int2002; 90(6): 554–557
CrossRef
Pubmed
Google scholar
|
[34] |
BilenCY, OzenH, AkiFT, AygünC, EkiciS, KendiS. Clinical experience with BCG alone versus BCG plus epirubicin. Int J Urol2000; 7(6): 206–209
CrossRef
Pubmed
Google scholar
|
[35] |
KuniedaF, KitamuraH, NiwakawaM, KuroiwaK, ShinoharaN, TobisuK, NakamuraK, ShibataT, TsuzukiT, TsukamotoT, KakehiY; Urologic Oncology Study Group of the Japan Clinical Oncology Group. Watchful waiting versus intravesical BCG therapy for high-grade pT1 bladder cancer with pT0 histology after second transurethral resection: Japan Clinical Oncology Group Study JCOG1019. Jpn J Clin Oncol2012; 42(11): 1094–1098
CrossRef
Pubmed
Google scholar
|
[36] |
BabjukM, OosterlinckW, SylvesterR, KaasinenE, BöhleA, Palou-RedortaJ; European Association of Urology (EAU). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol2008; 54(2): 303–314
Pubmed
|
[37] |
KoskelaLR, PoljakovicM, EhrénI, WiklundNP, de VerdierPJ. Localization and expression of inducible nitric oxide synthase in patients after BCG treatment forbladder cancer. Nitric Oxide. 2012; 15;27(3): 185–91.
|
[38] |
KempTJ, LudwigAT, EarelJK, MooreJM, VanoostenRL, MosesB, LeidalK, NauseefWM, GriffithTS. Neutrophil stimulation with Mycobacterium bovis bacillus Calmette-Guérin (BCG) results in the release of functional soluble TRAIL/Apo-2L. Blood2005; 106(10): 3474–3482
CrossRef
Pubmed
Google scholar
|
[39] |
HallMC, ChangSS, DalbagniG, PruthiRS, SeigneJD, SkinnerEC, WolfJS Jr, SchellhammerPF. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol2007; 178(6): 2314–2330
CrossRef
Pubmed
Google scholar
|
[40] |
MalmströmPU, WijkströmH, LundholmC, WesterK, BuschC, NorlénBJ; Swedish-Norwegian Bladder Cancer Study Group. 5-year follow-up of a randomized prospective study comparing mitomycin C and bacillus Calmette-Guérin in patients with superficial bladder carcinoma. J Urol1999; 161(4): 1124–1127
CrossRef
Pubmed
Google scholar
|
[41] |
BöhleA. Intravesical bacillus Calmette-Guérin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. Int Braz J Urol2002; 28(6): 585–586
Pubmed
|
/
〈 | 〉 |