For patients with high-risk nonmuscle invasive bladder cancer (NMIBC), instilling bacillus Calmette-Guérin (BCG) is associated with better cancer-specific survival than upfront cystectomy alone, according to new study findings presented during the AUA 2020 virtual experience.

During 1997 to 2014 in Sweden, 10,209 individuals had high-risk NMIBC (median age 71 years; 80% male). Of these, 5660 patients underwent transurethral resection of bladder tumor (TURBT) only and 3862 received initial BCG. Upfront radical cystectomy was performed in 687 patients, whereas 399 had delayed cystectomy after BCG.

Over 5 years, cancer-specific survival appeared higher for patients receiving BCG than upfront cystectomy or TURBT alone: 85% vs 75% vs 65%, respectively, Eugen Wang, MD, PhD, of the Center for Andrology and Urology in Eskilstuna, Sweden, and colleagues reported. In a Cox proportional hazards model, initial treatment with BCG was associated with better survival, along with younger patient age, lower cancer stage, and treatment in a high-volume academic hospital. Selection bias could not be ruled out, however.

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Wang E, Larsson U, Gårdmark T, Malmstr€om P-U. The outcome of patients with high-risk non-muscle invasive bladder cancer in Sweden. Presented at the American Urological Association 2020 Virtual Experience, May 15-19, 2020. Abstract MP72-10.