TY  - JOUR
T1  - Outcomes of BCG Therapy in Patients with High and Very High-Risk Non-Muscle-Invasive Bladder Cancer: Reassessing EAU Risk Stratification
TT  - Yüksek ve Çok Yüksek Riskli Kasa İnvaziv Olmayan Mesane Kanserli Hastalarda BCG Tedavisinin Sonuçları: EAU Risk Sınıflandırmasının Yeniden Değerlendirilmesi
AU  - İplikçi, Ayberk
AU  - Arıkan, Özgür
AU  - Kazan, Hüseyin Özgür
AU  - Keleş, Ahmet
AU  - Keser, Ferhat
AU  - Hamıdzada, Ilkın
AU  - Çakıcı, Mehmet Çağlar
AU  - Çulpan, Meftun
AU  - Yıldırım, Asıf
PY  - 2025
DA  - October
Y2  - 2025
DO  - 10.33719/nju1721821
JF  - The New Journal of Urology
JO  - New J Urol
PB  - Ali İhsan TAŞÇI
WT  - DergiPark
SN  - 3023-6940
SP  - 166
EP  - 174
VL  - 20
IS  - 3
LA  - en
AB  - 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.
KW  - Bacillus Calmette-Guerin (BCG) therapy
KW  - EAU risk stratification
KW  - non-muscle invasive bladder cancer (NMIBC)
N2  - 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.
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UR  - https://doi.org/10.33719/nju1721821
L1  - https://dergipark.org.tr/tr/download/article-file/4968697
ER  -