MP08-09: Down-staging in AUA risk stratification after intravesical bacillus Calmette-Guerin therapy has favorable effect on recurrence free survival after 2nd line intravesical gemcitabine chemotherapy
Introduction: Despite intravesical bacillus Calmette-Guerin (BCG) therapy, 40% of non-muscle invasive bladder cancer (NMIBC) patients experience tumor recurrence within 2 years. Subsequent intravesical chemotherapy is an alternative option. We evaluated the effect of down-staging in American Urological Association (AUA) risk stratification after intravesical BCG therapy on recurrence free survival (RFS) after 2nd line intravesical gemcitabine chemotherapy. Methods: Out of 78 patients who received intravesical gemcitabine therapy from 2019 to 2022, 50 patients who received intravesical BCG (1st line) and gemcitabine (2nd line) therapy were identified. We determined the AUA risk group at the initial diagnosis of NMIBC and after the surgical treatment for tumor recurrence despite intravesical BCG therapy. The risk group migration after intravesical BCG therapy were analyzed. Kaplan-Meier analysis was performed to estimate RFS after intravesical gemcitabine therapy. Results: Median number of intravesical BCG and gemcitabine therapy were 9 and 10, respectively. At initial diagnosis, 5 (10.0%), 12 (24.0%) and 33 (66.0%) cases were classified as low, intermediate and high risk group, respectively. After intravesical BCG therapy, 11 of up-staging and 8 of down-staging events occurred leading to 7 (14.0%), 6 (12.0%) and 37 (74.0%) patients stratified as low, intermediate and high risk group, respectively. RFS rate after 2nd line intravesical gemcitabine was significantly higher in the down-staging cases than the other cases (Log rank p = 0.039). Median time to recurrence in the down-staging group and the other group were not reached and 13 months, respectively. Conclusions: Recurrence free survival rate after 2nd line intravesical gemcitabine therapy was higher in the patients who experienced risk group down-staging after 1st line intravesical BCG therapy. SOURCE OF Funding: None
