📃 Paper Title: Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials
🧍 Author: Sylvester
🕒 Year: 2002
📚 Journal: Journal of Urology
🌎 Country: Belgium
ㅤContext to the study:
How will you manage intermediate and high-risk superficial bladder cancer after the TURBT?
ㅤ✅ Take-home message of study:
In patients undergoing transurethral resection for superficial bladder cancer, the utilization of Intravesical BCG (induction followed by maintenance therapy) substantially diminishes the likelihood of progression.
BCG is a preferred therapeutic option for patients with intermediate and high-risk papillary tumors, as well as those with carcinoma in situ.
ㅤ Systematic review and meta-analysis
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Study participants:
24 trials with progression information on 4,863 patients were analysed.
Comparing transurethral resection plus intravesical BCG to either resection alone or resection plus another treatment other than BCG.
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Key study outcomes:
Median follow-up of 2.5 years (but up to 15 years)
9.8% of patients on BCG had progression compared to 13.8% of patients in the control groups.
This corresponded to a reduction of 27% in the odds of progression on BCG (OR 0.73, p = 0.001).
The percentage of patients with progression was low (6.4% of patients with papillary tumors and 13.9% of patients with carcinoma in situ).
Only patients receiving maintenance BCG benefited.
There was no statistically significant difference in treatment effect for either overall survival or death due to bladder cancer.
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Study Limitations:
The low rates of progression reflected the short follow-up and relatively low-risk patients entered in many of the trials.
Multiple trials (24 in total): some are smaller, single-center series and likely significant heterogeneity exists between sites.
Mixing of populations present in control arms (TURBT alone combined with TURBT and other treatments).
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