표재성 방광암의 Bacillus Calmette-Guerin 방광 내 주입요법: 5년 이상 추적 결과

Abstract

Purpose: The long-term outcome of intravesical Bacillus Calmette-Guerin (BCG) therapy for superficial bladder cancer is not well known. We evaluated the results of minimum 5 year follow up of superficial bladder cancer patients who were treated with transurethral resection (TUR) combined with intravesical BCG therapy. Materials and Methods: Between July 1985 and June 1997, 120 patients with superficial bladder cancer were treated with TUR and intravesical BCG, and were followed for at least 5 years. The mean follow-up duration was 87 months. Thirty-eight patients had Ta tumors, 60 T1 and 22 CIS. The tumor grades were I, II and III, by the WHO grading, in 24, 65 and 31 patients, respectively. Results: Of the 120 patients, the tumor recurred in 44 and progressed in 19, at a median of 12 and 28 months, respectively. Thirty-one (70.5%) of the recurrences and 16 (85%) of the progressions were found within 5 years of the BCG. The complete responses after first and second courses of BCG were 92 and 100% in Ta, 60 and 33% in T1 and 52 and 55% in CIS, respectively. The 5 and 10 year progression free survival rates, and disease specific survival rates, were 89.8 and 70.3%, and 85.1 and 76%, respectively. Twenty-two died of bladder cancer. Conclusions: TUR and intravesical BCG are successful in controlling the majority of superficial bladder cancers in long-term follow-up. Most of recurrences and progressions developed within 5 years of the BCG, but a significant numbers of recurrences occurred after 5 years. Therefore, close follow-up is still needed at over 5 years after BCG therapy. (Korean J Urol 2003;44:573-578) Key Words: Bladder neoplasms, BCG vaccine, Recurrence, Disease progression