How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment
Abstract. Background. Severe functional impairment is often considered a contraindication to intravesical therapy for nonmuscle-invasive bladder cancer (NMIBC). A tailored intravesical bacillus Calmette-Guérin (BCG) procedure was evaluated in high-risk (HR)-NMIBC patients with severe functional impa...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-09-01
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| Series: | Current Urology |
| Online Access: | http://journals.lww.com/10.1097/CU9.0000000000000134 |
| _version_ | 1828056010188652544 |
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| author | Luca Di Gianfrancesco Mauro Ragonese Massimiliano Foti Giuseppe Palermo Emilio Sacco PierFrancesco Bassi Marco Racioppi |
| author_facet | Luca Di Gianfrancesco Mauro Ragonese Massimiliano Foti Giuseppe Palermo Emilio Sacco PierFrancesco Bassi Marco Racioppi |
| author_sort | Luca Di Gianfrancesco |
| collection | DOAJ |
| description | Abstract. Background. Severe functional impairment is often considered a contraindication to intravesical therapy for nonmuscle-invasive bladder cancer (NMIBC). A tailored intravesical bacillus Calmette-Guérin (BCG) procedure was evaluated in high-risk (HR)-NMIBC patients with severe functional impairment.
Materials and methods. Patients with a Katz Index score of 2 or less and an initial diagnosis of HR-NMIBC with atraumatic insertion of a Foley-type indwelling catheter, bladder emptying, and BCG instillation were prospectively treated; after 2 hours, the bladder was emptied and the catheter was removed (group A).
After propensity score matching, 52 patients in group A were compared with that of 52 consecutive patients in group B using a retrospective database, with similar baseline/oncological characteristics and treated with standard intermittent catheterization. Moreover, groups A and B were compared with that of 130 consecutive patients (group C) retrospectively evaluated, with similar oncological characteristics but with a Katz Index score of 3 or greater and treated with standard intermittent catheterization.
Results. The discontinuation rates were 11.5%, 35%, and 9% in groups A, B, and C, respectively (A vs. B, log-rank score 42.52 [p < 0.05]; B vs. C, 107.6 [p < 0.05]; A vs. C, 3.45 [p > 0.05]). The overall adverse event rates were 38.5%, 57.7%, and 39.2%, respectively (A vs. B, p = 0.04; B vs. C, 0.03; A vs. C, 0.92). The rates of severe adverse events were 1.9%, 1.9%, and 1.5%, respectively, without statistically significant differences. The cumulative HR disease-free survival rates were 63.4%, 48%, and 69.2%, respectively (A vs. B, log-rank score 154.9 [p < 0.05]; B vs. C, 415 [p < 0.05]; A vs. C, 244 [p < 0.05]).
Conclusions. A tailored intravesical instillation procedure may reduce BCG discontinuation and adverse effects. |
| first_indexed | 2024-04-10T20:47:37Z |
| format | Article |
| id | doaj.art-0e1db2e879d841cba6513bdc57a66f78 |
| institution | Directory Open Access Journal |
| issn | 1661-7649 |
| language | English |
| last_indexed | 2024-04-10T20:47:37Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Current Urology |
| spelling | doaj.art-0e1db2e879d841cba6513bdc57a66f782023-01-24T00:57:05ZengWolters Kluwer HealthCurrent Urology1661-76492022-09-0116316016710.1097/CU9.0000000000000134202209000-00008How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairmentLuca Di Gianfrancesco0Mauro Ragonese1Massimiliano Foti2Giuseppe Palermo3Emilio Sacco4PierFrancesco Bassi5Marco Racioppi6Clinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyClinica Urologica, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS–Università Cattolica del Sacro Cuore di Roma, Rome, ItalyAbstract. Background. Severe functional impairment is often considered a contraindication to intravesical therapy for nonmuscle-invasive bladder cancer (NMIBC). A tailored intravesical bacillus Calmette-Guérin (BCG) procedure was evaluated in high-risk (HR)-NMIBC patients with severe functional impairment. Materials and methods. Patients with a Katz Index score of 2 or less and an initial diagnosis of HR-NMIBC with atraumatic insertion of a Foley-type indwelling catheter, bladder emptying, and BCG instillation were prospectively treated; after 2 hours, the bladder was emptied and the catheter was removed (group A). After propensity score matching, 52 patients in group A were compared with that of 52 consecutive patients in group B using a retrospective database, with similar baseline/oncological characteristics and treated with standard intermittent catheterization. Moreover, groups A and B were compared with that of 130 consecutive patients (group C) retrospectively evaluated, with similar oncological characteristics but with a Katz Index score of 3 or greater and treated with standard intermittent catheterization. Results. The discontinuation rates were 11.5%, 35%, and 9% in groups A, B, and C, respectively (A vs. B, log-rank score 42.52 [p < 0.05]; B vs. C, 107.6 [p < 0.05]; A vs. C, 3.45 [p > 0.05]). The overall adverse event rates were 38.5%, 57.7%, and 39.2%, respectively (A vs. B, p = 0.04; B vs. C, 0.03; A vs. C, 0.92). The rates of severe adverse events were 1.9%, 1.9%, and 1.5%, respectively, without statistically significant differences. The cumulative HR disease-free survival rates were 63.4%, 48%, and 69.2%, respectively (A vs. B, log-rank score 154.9 [p < 0.05]; B vs. C, 415 [p < 0.05]; A vs. C, 244 [p < 0.05]). Conclusions. A tailored intravesical instillation procedure may reduce BCG discontinuation and adverse effects.http://journals.lww.com/10.1097/CU9.0000000000000134 |
| spellingShingle | Luca Di Gianfrancesco Mauro Ragonese Massimiliano Foti Giuseppe Palermo Emilio Sacco PierFrancesco Bassi Marco Racioppi How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment Current Urology |
| title | How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment |
| title_full | How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment |
| title_fullStr | How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment |
| title_full_unstemmed | How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment |
| title_short | How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment |
| title_sort | how to reduce bacillus calmette guerin discontinuation in patients with severe functional impairment |
| url | http://journals.lww.com/10.1097/CU9.0000000000000134 |
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