Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer

Bladder cancer (BC) is the most important tumor problem of urologic cancer. Therefore, noninvasive urinary biomarkers were used for diagnosis of BC. However, the new biomarkers failed to reach higher accuracy. The aim of this study was to assess the diagnostic efficacy of nuclear matrix protein-22 (NMP- 22), nuclear matrix protein-52 (NMP-52), urinary cytology and to investigate combinations of urine NMP-52 with urinary cytology as noninvasive biomarkers to increase diagnostic performance of bladder cancer at different grades and stages. Overall, there were 156 subjects (62 BC, 54 cystitis patients and 40 healthy volunteers). The NMP-22 and NMP-52 were quantified in urine samples by ELISA. The urinary cytology is used by some physicians routinely for diagnosis of BC. The sensitivity and specificity for NMP-52 were 94% and 82%, for NMP-22 69% and 80.8% and for cytology 56% and 94.6% respectively and also, both urinary NMP-22 and NMP-52 have extremely significant relation (p<0.0001) to BC vs. healthy individuals and cystitis patients. Moreover, the combination of NMP- 52 with urinary cytology could predict all BC stages and grade with 95.6% sensitivity and 94.3% specificity. In conclusion, NMP-52 and urinary cytology in combination improve diagnostic performance for BC detection in different pathological types.

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Clinical outcomes in a cohort of patients with T1 high grade urothelial bladder cancer not receiving intravesical bacillus Calmette-Guerin: a 15 year experience

Ceylon Medical Journal ◽

10.4038/cmj.v63i1.8626 ◽

2018 ◽

Vol 63 (1) ◽

pp. 37

Author(s):

S A S Goonewardena ◽

U Jayarajah ◽

S N Kuruppu ◽

H M K B Herath ◽

D M H Fernando ◽

...

Keyword(s):

Bladder Cancer ◽

Clinical Outcomes ◽

High Grade ◽

Bacillus Calmette Guerin ◽

Urothelial Bladder Cancer ◽

Urothelial Bladder

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Possibile ruolo della citofluorometria (CFM) nel monitoraggio della risposta alla terapia endocavitaria con BCG nel carcinoma in situ della vescica: Monitoring the response to intravesical BCG in the treatment of cis: A possible role of flow cytometry

Urologia Journal ◽

10.1177/039156039506200212 ◽

1995 ◽

Vol 62 (2) ◽

pp. 245-247

Author(s):

M. De Siati ◽

D. Grassi ◽

N. Franzolin ◽

L.S. Azzolina

Keyword(s):

Flow Cytometry ◽

Carcinoma In Situ ◽

Recurrent Disease ◽

Intravesical Therapy ◽

Urinary Cytology ◽

Bacillus Calmette Guerin ◽

Intravesical Bcg

We report our experience on the treatment of carcinoma in situ (CIS) using intravesical therapy with the Bacillus Calmette-Guerin (BCG). From November 1992 to September 1994, 18 patients received treatment: 6 had associated CIS and 12 secondary CIS. Ploidy of each tumour was determined by flow cytometry. Aneuploidy was found in 12 cases, diploidy in 6 cases. After treatment, a standard bladder mapping was performed: 14 patients showed no evidence of cystoscopic and histological disease and if previously aneuploid, became diploid. 4 patients has recurrent disease after therapy; they were all aneuploid before treatment. One of these showed a persistent aneuploidy, although both voided urinary cytology and histological samples were negative. Six months later, a recurrent CIS was seen at the time of cystoscopy. These results enhance the interest in flow cytometry as a possible predictor of response to BCG in the treatment of CIS.

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Radical Cystectomy Against Intravesical BCG for High-Risk High-Grade Nonmuscle Invasive Bladder Cancer: Results From the Randomized Controlled BRAVO-Feasibility Study

Journal of Clinical Oncology ◽

10.1200/jco.20.01665 ◽

2020 ◽

pp. JCO.20.01665

Author(s):

James W. F. Catto ◽

Kathryn Gordon ◽

Michelle Collinson ◽

Heather Poad ◽

Maureen Twiddy ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Radical Cystectomy ◽

Controlled Trial ◽

Invasive Bladder Cancer ◽

High Grade ◽

Bacillus Calmette Guerin ◽

Randomized Controlled ◽

Number Of Patients ◽

Nonmuscle Invasive Bladder Cancer

PURPOSE High-grade nonmuscle invasive bladder cancer (HRNMIBC) is a heterogeneous disease. Treatments include intravesical maintenance Bacillus Calmette-Guerin (mBCG) and radical cystectomy (RC). We wanted to understand whether a randomized trial comparing these options was possible. MATERIALS AND METHODS We conducted a two-arm, prospective multicenter randomized study to determine the feasibility in Bacillus Calmette-Guerin-naive patients. Participants had new high-risk HRNMIBC suitable for both treatments. Random assignment was stratified by age, sex, center, stage, presence of carcinoma in situ, and prior low-risk bladder cancer. Qualitative work investigated how to maintain equipoise. The primary outcome was the number of patients screened, eligible, recruited, and randomly assigned. RESULTS We screened 407 patients, approached 185, and obtained consent from 51 (27.6%) patients. Of these, one did not proceed and therefore 50 were randomly assigned (1:1). In the mBCG arm, 23/25 (92.0%) patients received mBCG, four had nonmuscle invasive bladder cancer (NMIBC) after induction, three had NMIBC at 4 months, and four received RC. At closure, two patients had metastatic BC. In the RC arm, 20 (80.0%) participants received cystectomy, including five (25.0%) with no tumor, 13 (65.0%) with HRNMIBC, and two (10.0%) with muscle invasion in their specimen. At follow-up, all patients in the RC arm were free of disease. Adverse events were mostly mild and equally distributed (15/23 [65.2%] patients with mBCG and 13/20 [65.0%] patients with RC). The quality of life (QOL) of both arms was broadly similar at 12 months. CONCLUSION A randomized controlled trial comparing mBCG and RC will be challenging to recruit into. Around 10% of patients with high-risk HRNMIBC have a lethal disease and may be better treated by primary radical treatment. Conversely, many are suitable for bladder preservation and may maintain their prediagnosis QOL.

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