Beware the BCG failures: A review of one institution's results

Objective: To review the outcome of all superficial transitional cell (TCC) bladder cancer treated with intravesical Bacille Calmette-Guerin (BCG) at one institution and, in particular, the prognosis for those patients who gained little benefit from BCG therapy. Patients and Methods: The notes of 122 patients treated with BCG over a nine-year period were reviewed. The following details were recorded: time of diagnosis; time of decision to treat with BCG; results of cystoscopies before and after BCG; duration of follow up; time of progression if occurred, mortality and cause of death. Results: Complete follow up data was available for 112 patients. At a median follow up of 23 months (range 3-107) 57 patients (51%) remained free of tumour, 30 (27%) had progressed and 18 (16%) had died of transitional cell carcinoma. There was a significant association between a positive initial check cystoscopy and subsequent progression (p < 0.001) and disease specific mortality (p < 0.001). Of the 35 patients who had a positive cystoscopy after BCG treatment 21 (60%) progressed and 14 (40%) died of transitional cell carcinoma compared with 9 (12%) and 4 (5%) of the 77 with a negative cystoscopy. Adjusted odds ratios for progression and death from TCC for patients with a positive initial check cystoscopy were 21 and 13, respectively. Conclusion: In our series the patients found to have tumour at the initial check cystoscopy following intravesical BCG had a poor prognosis. This should be remembered when considering treatment options and counselling patients. Follow up of all BCG patients -need to be rigorous and protocols would help to unify the treatment patients receive. (C) 2002 Elsevier Science B.V. All rights reserved.