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Comparative Study
. 2025 Feb;135(2):260-268.
doi: 10.1111/bju.16509. Epub 2024 Aug 25.

Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer

Jacob I Taylor  1 , Ashish M Kamat  2 , Michael A O'Donnell  3 , Drupad Annapureddy  1 , Jeffrey Howard  1 , Wei Shen Tan  2 , Ian McElree  3 , Facundo Davaro  4 , Kendrick Yim  5 , Stephen Harrington  6 , Elizabeth Dyer  6 , Anna J Black  7 , Pratik Kanabur  8 , Mathieu Roumiguié  9 , Seth Lerner  8 , Peter C Black  7 , Jay D Raman  6 , Mark A Preston  5 , Gary Steinberg  10 , William Huang  10 , Roger Li  4 , Vignesh T Packiam  3 , Solomon L Woldu  1 , Yair Lotan  1
Affiliations
Comparative Study

Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer

Jacob I Taylor et al. BJU Int. 2025 Feb.

Abstract

Objective: To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).

Patients and methods: Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.

Results: Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).

Conclusion: In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.

Keywords: BCG‐unresponsive; Bladder‐sparing therapy; intravesical therapy; radical cystectomy; urinary bladder neoplasms.

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Figures

Fig. 1
Fig. 1
Oncological outcomes of the entire cohort. Kaplan–Meier curves showing MFS (A), CSS (B), and OS (C).
See this image and copyright information in PMC

References

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