Del Giudice, Francesco and Santarelli, Valerio and Laszkiewicz, Jan and Li, Shufeng and Krajewski, Wojciech and Nowak, Ukasz and Szydelko, Tomasz and Ferro, Matteo and Rocco, Bernardo and Crocetto, Felice and Barone, Biagio and Buonerba, Carlo and Contieri, Roberto and Pichler, Renate and Subiela, Jose Daniel and Pradere, Benjamin and Moschini, Marco and Mari, Andrea and Mori, Keiichiro and Soria, Francesco and Mayr, Roman and Jo, Jung Ki and Gad, Mohamed and Challacombe, Ben and Abu-Ghanem, Yasmin and Mensah, Elsie and Nair, Rajesh and Thurairaja, Ramesh and Khan, Muhammad Shamim and Chung, Benjamin I. (2025) The influence of immunocompromised status on recurrence and progression free survival among nonmuscle invasive bladder cancers (NMIBCs) undergoing transurethral resection of bladder tumor (TURBT) and adjuvant intravesical bacillus Calmette Guerin (BCG): Analysis of USA insurance claim data. UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS, 43 (12). 693000000000-6.93E+020. ISSN 1078-1439, 1873-2496
Full text not available from this repository. (Request a copy)Abstract
Introduction: Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients. Materials and Methods: Patients aged >= 18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the MerativeTM Marketscan (R) Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted. Results: Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56). Conclusions: BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MITOMYCIN-C; METAANALYSIS; VACCINATION; INFECTION; CARCINOMA; THERAPY; Bladder cancer (BC); Bacillus Calmette-Guerin (BCG); Immunodepression; Transurethral resection of bladder tumor (TURBT) |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Mar 2026 09:32 |
| Last Modified: | 30 Mar 2026 09:32 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67921 |
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