Yüksek ve Çok Yüksek Riskli Kasa İnvaziv Olmayan Mesane Kanserli Hastalarda BCG Tedavisinin Sonuçları: EAU Risk Sınıflandırmasının Yeniden Değerlendirilmesi

Year 2025, Volume: 20 Issue: 3, 166 - 174, 20.10.2025

Özgür Arıkan , Ayberk İplikçi , Hüseyin Özgür Kazan , Ahmet Keleş , Ferhat Keser , Ilkın Hamıdzada , Mehmet Çağlar Çakıcı , Meftun Çulpan , Asıf Yıldırım

https://doi.org/10.33719/nju1721821

Abstract

Amaç: Bacillus Calmette-Guérin (BCG) immünoterapisi ile tedavi edilen yüksek riskli (HR) ve çok yüksek riskli (VHR) kasa invaziv olmayan mesane kanseri (NMIBC) hastalarının onkolojik sonuçlarını değerlendirmek ve yeni Avrupa Üroloji Birliği (EAU) risk sınıflandırmasını değerlendirmek.
Yöntemler: Bu retrospektif kohort çalışmada Ocak 2015 ile Ocak 2024 arasında BCG tedavisi gören 211 HR ve VHR NMIBC hastasından alınan veriler analiz edildi. Risk sınıflandırması EAU NMIBC risk hesaplayıcısı kullanılarak yapıldı. Nüks, progresyon, nükssüz sağkalım (RFS) ve progresyonsuz sağkalım (PFS) değerlendirildi.
Bulgular: Kohort 144 (%68,2) HR ve 67 (%31,8) VHR hastasından oluşuyordu. VHR grubunda önemli ölçüde daha fazla olumsuz patolojik özellik vardı (daha büyük ve çoklu tümörler, daha yüksek pT evresi, CIS, varyant histoloji, lenfovasküler invazyon, tümör nekrozu). HR ve VHR grupları arasında genel nüks (33,3% - 37,3%, p=0,572) veya progresyon oranlarında (%10,4 - 9%, p=0,741) önemli bir fark bulunmazken, 5 yıllık RFS VHR'de önemli ölçüde daha düşüktü (%56 - %75, p=0,003). 5 yıllık PFS gruplar arasında benzerdi (%86 - %91, p=0,311).
Sonuç: VHR grubu daha agresif tümör özellikleri gösterse de, BCG tedavisi HR grubuyla karşılaştırıldığında benzer genel ilerleme oranlarıyla sonuçlandı. Bu bulgular, EAU risk sınıflandırmasının BCG ile tedavi edilen hastalarda, özellikle VHR olarak sınıflandırılanlarda ilerleme riskini abartmış olabileceğini ve BCG'nin bu popülasyonda bile değerli bir tedavi seçeneği olmaya devam ettiğini düşündürmektedir.

Keywords

Kasa invaziv olmayan mesane kanseri (NMIBC) , EAU risk sınıflandırması , Bacillus Calmette-Guerin (BCG) tedavisi

Outcomes of BCG Therapy in Patients with High and Very High-Risk Non-Muscle-Invasive Bladder Cancer: Reassessing EAU Risk Stratification

Abstract

Objective: To evaluate the oncologic outcomes of high-risk (HR) and very high-risk (VHR) non-muscle-invasive bladder cancer (NMIBC) patients treated with Bacillus Calmette-Guérin (BCG) immunotherapy and assess the new European Association of Urology (EAU) risk stratification.
Material and Methods: This retrospective cohort study analyzed data from 211 HR and VHR NMIBC patients treated with BCG therapy between January 2015 and January 2024. Risk stratification was performed using the EAU NMIBC risk calculator. Recurrence, progression, recurrence-free survival (RFS), and progression-free survival (PFS) were assessed.
Results: The cohort comprised 144 (68.2%) HR and 67 (31.8%) VHR patients. The VHR group had significantly more adverse pathological features (larger and multiple tumors, higher pT stage, CIS, variant histology, lymphovascular invasion, tumor necrosis). While there was no significant difference in overall recurrence (33.3% vs. 37.3%, p=0.572) or progression rates (10.4% vs. 9%, p=0.741) between HR and VHR groups, the 5-year RFS was significantly lower in the VHR (56% vs. 75%, p=0.003). The 5-year PFS was similar between the groups (86% vs 91%, p=0.311).
Conclusion: In spite of the fact that the VHR group presented with more aggressive tumor characteristics, BCG therapy resulted in similar overall progression rates compared to the HR group. These findings suggest that the EAU risk stratification may overestimate the risk of progression in BCG-treated patients, particularly those classified as VHR, and that BCG remains a valuable treatment option even in this population.

Keywords

Bacillus Calmette-Guerin (BCG) therapy , EAU risk stratification , non-muscle invasive bladder cancer (NMIBC)

Ethical Statement

Istanbul Medeniyet University Göztepe Training and Research Hospital Clinical Research Ethics Committee Approved by the Ethics Committee. (Approval No: 2022/0560). All patients participating in the study were informed about the study, and their informed consent was obtained.

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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