Efficacy of bacillus Calmette-Guérin in the treatment of superficial bladder cancer: The impact of previous intravesical treatment

Objective: To clinically evaluate the role of intravesical bacillus Calmette-Guerin (BCG) in the management of superficial bladder cancer, focusing on dose, age, high grade/stage, and pretreatment episodes with other therapies in long-term follow-up patients. Methods: A total of 213 patients with superficial (Ta-T1) transitional cell carcinoma of the bladder received 6–8 weekly instillations of 40, 60 or 80 mg of Tokyo strain BCG. Further 6–8 monthly applications were given in some cases. Results: Recurrence-free and progression-free survival rates were compared with reference to dose, age, previous treatment, grade, stage, and high risk categories. Overall recurrence-free rates for 3, 5, and 10 years were 70.8%, 67.1%, and 57.6%, with progression-free survival rates of 94.5%, 93.6%, 90.6%, respectively. In univariate analyses, younger cases demonstrated higher recurrence-free survival rates, but without statistical significance (P = 0.1229). Recurrence-free rates were significantly higher for cases without previous intravesical treatment (P = 0.0010). There was no significant BCG dose-dependence. High grade and high stage patients were confirmed as having higher recurrence and progression rates. Conclusions: Intravesical instillation of BCG is the most effective in the long term when chosen as the initial prophylactic therapy for the prevention of recurrence in superficial bladder cancer.