Objective: The aim of this study is to determine whether BCG vaccine has the same effectivenes in the prevention of recurrences after TUR in patients with primary or recurrent group. In addition, to determine the predictive value of ppd test positivity for tumor recurency.
Materials and Methods: 94 patients (43 primary tumor and 51 recurrent tumor) enrolled to this study. All patients underwent TUR. By starting 15 days after surgery, 81 mg of intravesical BCG was administered for a 6 weeks duration. The treatment postponed or canceled for the patients who have severe hematuria or can not tolerate the treatment as well. Patients were checked by cystoscopy and urine cytology in the first year quarterly, in the second and third year by 6 monthly. PPD tests were performed before and after BCG treatment and recorded in both primary and recurrent groups. In both group, the number of tumor recurrence every months, monthly recurrence indexes and recurrence rates of 100 monthly were analyzed. The Chi-square test was used to compare results.
Results: Eighty-two male and 12 female patients included to this study The average age is 57.6 (38-70) . Fourty three of 94 patients with primary superficial bladder cancer and 51 patients were recurrent group because of they received at least one prior therapy (only TUR, TUR + epirubicin or TUR+interferon). The ppd test was negative in 33 of 43 patients in primary group (TUR plus intravesical BCG therapy) before BCG application. After BCG application 8 of the patients still have the negative ppd test, 6 of these 8 patients (75%) had recurrence in future Although the majority of PPD test was negative (29 of 51 patients) prior to treatment in the recurrent group, This number dropped to 15 after the treatment, and of these 12 of 15 patients (80%) had recurrence. The most important side effects related to BCG treatment are dysuria and microscopic hematuria. And they did not require discontinuation of BCG treatment. The recurrence indexes were 0,010 in the primary group. It was 0,183 and 0,208 in the recurrent group pre-treatment and post-treatment, respectively. According to the test results, the difference between the values before and after treatment of recurrent group was not statistically significant (P = 0.53). Bu there was a statistical difference between recurrent and primary groups in terms of recurrence (p <0.5).
Conclusion: Althought dose regime, application time and maintenance intervals are not clearly known, BCG is still effective for preventing recurrences and progression in moderate and high-risk superficial bladder cancer after TUR, and the side effects are acceptable and affordable. In addition, after the application of BCG, ppd test positivity is a positive finding for these patients.
Key Words: BCG, bladder cancer, intravesical therapy, immunotherapy
Abstract
Objective: The aim of this study is to determine whether BCG vaccine has the same effectivenes in the prevention of recurrences after TUR in patients with primary or recurrent group. In addition, to determine the predictive value of ppd test positivity for tumor recurency.
Materials and Methods: 94 patients (43 primary tumor and 51 recurrent tumor) enrolled to this study. All patients underwent TUR. By starting 15 days after surgery, 81 mg of intravesical BCG was administered for a 6 weeks duration. The treatment postponed or canceled for the patients who have severe hematuria or can not tolerate the treatment as well. Patients were checked by cystoscopy and urine cytology in the first year quarterly, in the second and third year by 6 monthly. PPD tests were performed before and after BCG treatment and recorded in both primary and recurrent groups. In both group, the number of tumor recurrence every months, monthly recurrence indexes and recurrence rates of 100 monthly were analyzed. The Chi-square test was used to compare results.
Results: Eighty-two male and 12 female patients included to this study The average age is 57.6 (38-70) . Fourty three of 94 patients with primary superficial bladder cancer and 51 patients were recurrent group because of they received at least one prior therapy (only TUR, TUR + epirubicin or TUR+interferon). The ppd test was negative in 33 of 43 patients in primary group (TUR plus intravesical BCG therapy) before BCG application. After BCG application 8 of the patients still have the negative ppd test, 6 of these 8 patients (75%) had recurrence in future Although the majority of PPD test was negative (29 of 51 patients) prior to treatment in the recurrent group, This number dropped to 15 after the treatment, and of these 12 of 15 patients (80%) had recurrence. The most important side effects related to BCG treatment are dysuria and microscopic hematuria. And they did not require discontinuation of BCG treatment. The recurrence indexes were 0,010 in the primary group. It was 0,183 and 0,208 in the recurrent group pre-treatment and post-treatment, respectively. According to the test results, the difference between the values before and after treatment of recurrent group was not statistically significant (P = 0.53). Bu there was a statistical difference between recurrent and primary groups in terms of recurrence (p <0.5).
Conclusion: Althought dose regime, application time and maintenance intervals are not clearly known, BCG is still effective for preventing recurrences and progression in moderate and high-risk superficial bladder cancer after TUR, and the side effects are acceptable and affordable. In addition, after the application of BCG, ppd test positivity is a positive finding for these patients.
Key Words: BCG, bladder cancer, intravesical therapy, immunotherapy