Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies

Drupad Annapureddy; Jacob I. Taylor; Ashish M. Kamat; Michael A. O'Donnell; Jeffrey Howard; Wei Shen Tan; Ian M. McElree; Facundo Davaro; Kendrick Yim; Stephen Harrington; Elizabeth Dyer; Anna J. Black; Pratik Kanabur; Mathieu Roumiguié; Seth Lerner; Peter C. Black; Jay D. Raman; Mark A. Preston; Gary Steinberg; William Huang; Roger Li; Vignesh T. Packiam; Solomon L. Woldu; Yair Lotan

doi:10.1016/j.euf.2025.01.001

Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies

Drupad Annapureddy, Jacob I. Taylor, Ashish M. Kamat, Michael A. O'Donnell, Jeffrey Howard, Wei Shen Tan, Ian M. McElree, Facundo Davaro, Kendrick Yim, Stephen Harrington, Elizabeth Dyer, Anna J. Black, Pratik Kanabur, Mathieu Roumiguié, Seth Lerner, Peter C. Black, Jay D. Raman, Mark A. Preston, Gary Steinberg, William HuangRoger Li, Vignesh T. Packiam, Solomon L. Woldu, Yair Lotan

Research output: Contribution to journal › Article › peer-review

Abstract

Background and objective: Current data on bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) do not differentiate outcomes by clinical stage. The purpose of this study is to investigate the role of tumor stage in oncologic outcomes in BCG-unresponsive NMIBC undergoing bladder-sparing therapies. Methods: Demographic and outcome data for patients with BCG-unresponsive NMIBC were reviewed at ten institutions. The Kaplan-Meier method was used to determine survival differences between the T1 ± carcinoma in situ (CIS), Ta alone, and CIS ± Ta groups. Exploratory analyses were conducted as follows: (1) T1 alone versus Ta alone versus CIS ± T1/Ta and (2) T1/Ta alone versus CIS ± T1/Ta. Key findings and limitations: Among 401 patients, 137 (34%) were T1 ± CIS, 104 (26%) Ta alone, and 160 (40%) CIS ± Ta. Disease progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.009) were increased in the T1 ± CIS group versus the Ta alone and CIS ± Ta groups. Cystectomy occurred most often in the CIS ± Ta and T1 groups (p = 0.002). Similar increases were noted in progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.004) in T1 alone patients versus the Ta alone and CIS ± T1/Ta groups. There were no differences in outcomes between the T1 alone and T1 + CIS groups. No significant differences in metastasis, bladder cancer mortality, or all-cause mortality were noted when comparing papillary disease only with any CIS. The primary limitation of this study is likely a selection bias due to the retrospective nature of the cohort. Conclusions and clinical implications: Presence of T1 disease is generally associated with worse oncologic outcomes compared with Ta or CIS. T1 and Ta should not be grouped together during comparison with CIS. Radical cystectomy appears largely driven by the presence of CIS.

Original language	English (US)
Journal	European Urology Focus
DOIs	https://doi.org/10.1016/j.euf.2025.01.001
State	Accepted/In press - 2025

All Science Journal Classification (ASJC) codes

Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.euf.2025.01.001

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Annapureddy, D., Taylor, J. I., Kamat, A. M., O'Donnell, M. A., Howard, J., Tan, W. S., McElree, I. M., Davaro, F., Yim, K., Harrington, S., Dyer, E., Black, A. J., Kanabur, P., Roumiguié, M., Lerner, S., Black, P. C., Raman, J. D., Preston, M. A., Steinberg, G., ... Lotan, Y. (Accepted/In press). Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies. European Urology Focus. https://doi.org/10.1016/j.euf.2025.01.001

@article{f1339189f4464eea963baada4a759335,

title = "Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Gu{\'e}rin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies",

abstract = "Background and objective: Current data on bacillus Calmette-Gu{\'e}rin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) do not differentiate outcomes by clinical stage. The purpose of this study is to investigate the role of tumor stage in oncologic outcomes in BCG-unresponsive NMIBC undergoing bladder-sparing therapies. Methods: Demographic and outcome data for patients with BCG-unresponsive NMIBC were reviewed at ten institutions. The Kaplan-Meier method was used to determine survival differences between the T1 ± carcinoma in situ (CIS), Ta alone, and CIS ± Ta groups. Exploratory analyses were conducted as follows: (1) T1 alone versus Ta alone versus CIS ± T1/Ta and (2) T1/Ta alone versus CIS ± T1/Ta. Key findings and limitations: Among 401 patients, 137 (34%) were T1 ± CIS, 104 (26%) Ta alone, and 160 (40%) CIS ± Ta. Disease progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.009) were increased in the T1 ± CIS group versus the Ta alone and CIS ± Ta groups. Cystectomy occurred most often in the CIS ± Ta and T1 groups (p = 0.002). Similar increases were noted in progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.004) in T1 alone patients versus the Ta alone and CIS ± T1/Ta groups. There were no differences in outcomes between the T1 alone and T1 + CIS groups. No significant differences in metastasis, bladder cancer mortality, or all-cause mortality were noted when comparing papillary disease only with any CIS. The primary limitation of this study is likely a selection bias due to the retrospective nature of the cohort. Conclusions and clinical implications: Presence of T1 disease is generally associated with worse oncologic outcomes compared with Ta or CIS. T1 and Ta should not be grouped together during comparison with CIS. Radical cystectomy appears largely driven by the presence of CIS.",

author = "Drupad Annapureddy and Taylor, {Jacob I.} and Kamat, {Ashish M.} and O'Donnell, {Michael A.} and Jeffrey Howard and Tan, {Wei Shen} and McElree, {Ian M.} and Facundo Davaro and Kendrick Yim and Stephen Harrington and Elizabeth Dyer and Black, {Anna J.} and Pratik Kanabur and Mathieu Roumigui{\'e} and Seth Lerner and Black, {Peter C.} and Raman, {Jay D.} and Preston, {Mark A.} and Gary Steinberg and William Huang and Roger Li and Packiam, {Vignesh T.} and Woldu, {Solomon L.} and Yair Lotan",

note = "Publisher Copyright: {\textcopyright} 2025 European Association of Urology",

year = "2025",

doi = "10.1016/j.euf.2025.01.001",

language = "English (US)",

journal = "European Urology Focus",

issn = "2405-4569",

publisher = "Elsevier B.V.",

}

Annapureddy, D, Taylor, JI, Kamat, AM, O'Donnell, MA, Howard, J, Tan, WS, McElree, IM, Davaro, F, Yim, K, Harrington, S, Dyer, E, Black, AJ, Kanabur, P, Roumiguié, M, Lerner, S, Black, PC, Raman, JD, Preston, MA, Steinberg, G, Huang, W, Li, R, Packiam, VT, Woldu, SL & Lotan, Y 2025, 'Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies', European Urology Focus. https://doi.org/10.1016/j.euf.2025.01.001

TY - JOUR

T1 - Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies

AU - Annapureddy, Drupad

AU - Taylor, Jacob I.

AU - Kamat, Ashish M.

AU - O'Donnell, Michael A.

AU - Howard, Jeffrey

AU - Tan, Wei Shen

AU - McElree, Ian M.

AU - Davaro, Facundo

AU - Yim, Kendrick

AU - Harrington, Stephen

AU - Dyer, Elizabeth

AU - Black, Anna J.

AU - Kanabur, Pratik

AU - Roumiguié, Mathieu

AU - Lerner, Seth

AU - Black, Peter C.

AU - Raman, Jay D.

AU - Preston, Mark A.

AU - Steinberg, Gary

AU - Huang, William

AU - Li, Roger

AU - Packiam, Vignesh T.

AU - Woldu, Solomon L.

AU - Lotan, Yair

PY - 2025

Y1 - 2025

N2 - Background and objective: Current data on bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) do not differentiate outcomes by clinical stage. The purpose of this study is to investigate the role of tumor stage in oncologic outcomes in BCG-unresponsive NMIBC undergoing bladder-sparing therapies. Methods: Demographic and outcome data for patients with BCG-unresponsive NMIBC were reviewed at ten institutions. The Kaplan-Meier method was used to determine survival differences between the T1 ± carcinoma in situ (CIS), Ta alone, and CIS ± Ta groups. Exploratory analyses were conducted as follows: (1) T1 alone versus Ta alone versus CIS ± T1/Ta and (2) T1/Ta alone versus CIS ± T1/Ta. Key findings and limitations: Among 401 patients, 137 (34%) were T1 ± CIS, 104 (26%) Ta alone, and 160 (40%) CIS ± Ta. Disease progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.009) were increased in the T1 ± CIS group versus the Ta alone and CIS ± Ta groups. Cystectomy occurred most often in the CIS ± Ta and T1 groups (p = 0.002). Similar increases were noted in progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.004) in T1 alone patients versus the Ta alone and CIS ± T1/Ta groups. There were no differences in outcomes between the T1 alone and T1 + CIS groups. No significant differences in metastasis, bladder cancer mortality, or all-cause mortality were noted when comparing papillary disease only with any CIS. The primary limitation of this study is likely a selection bias due to the retrospective nature of the cohort. Conclusions and clinical implications: Presence of T1 disease is generally associated with worse oncologic outcomes compared with Ta or CIS. T1 and Ta should not be grouped together during comparison with CIS. Radical cystectomy appears largely driven by the presence of CIS.

AB - Background and objective: Current data on bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) do not differentiate outcomes by clinical stage. The purpose of this study is to investigate the role of tumor stage in oncologic outcomes in BCG-unresponsive NMIBC undergoing bladder-sparing therapies. Methods: Demographic and outcome data for patients with BCG-unresponsive NMIBC were reviewed at ten institutions. The Kaplan-Meier method was used to determine survival differences between the T1 ± carcinoma in situ (CIS), Ta alone, and CIS ± Ta groups. Exploratory analyses were conducted as follows: (1) T1 alone versus Ta alone versus CIS ± T1/Ta and (2) T1/Ta alone versus CIS ± T1/Ta. Key findings and limitations: Among 401 patients, 137 (34%) were T1 ± CIS, 104 (26%) Ta alone, and 160 (40%) CIS ± Ta. Disease progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.009) were increased in the T1 ± CIS group versus the Ta alone and CIS ± Ta groups. Cystectomy occurred most often in the CIS ± Ta and T1 groups (p = 0.002). Similar increases were noted in progression (p < 0.001), metastasis (p < 0.001), and bladder cancer mortality (p = 0.004) in T1 alone patients versus the Ta alone and CIS ± T1/Ta groups. There were no differences in outcomes between the T1 alone and T1 + CIS groups. No significant differences in metastasis, bladder cancer mortality, or all-cause mortality were noted when comparing papillary disease only with any CIS. The primary limitation of this study is likely a selection bias due to the retrospective nature of the cohort. Conclusions and clinical implications: Presence of T1 disease is generally associated with worse oncologic outcomes compared with Ta or CIS. T1 and Ta should not be grouped together during comparison with CIS. Radical cystectomy appears largely driven by the presence of CIS.

UR - http://www.scopus.com/inward/record.url?scp=85217360633&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85217360633&partnerID=8YFLogxK

U2 - 10.1016/j.euf.2025.01.001

DO - 10.1016/j.euf.2025.01.001

M3 - Article

C2 - 39922753

AN - SCOPUS:85217360633

SN - 2405-4569

JO - European Urology Focus

JF - European Urology Focus

ER -

Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non–muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies

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