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Refining BCG-failure classifications in non-muscle-invasive bladder cancer
Aleksander Ślusarczyk1, Pietro Scilipoti2,3, Roberto Contieri4
1Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland.
BJU International
|March 20, 2026
Summary
Bacillus Calmette-Guérin (BCG) treatment for bladder cancer shows poor outcomes for BCG-unresponsive and BCG-exposed non-muscle-invasive bladder cancer (NMIBC). Refined classification reveals varied prognoses, with late relapses having worse outcomes than very late relapses.
Area of Science:
- Urology
- Oncology
- Cancer Research
Background:
- Non-muscle-invasive bladder cancer (NMIBC) treatment often involves Bacillus Calmette-Guérin (BCG).
- Defining BCG-unresponsive and BCG-exposed NMIBC is crucial for prognosis.
- Heterogeneity in outcomes among BCG failure types requires investigation.
Purpose of the Study:
- To validate International Bladder Cancer Group (IBCG) definitions for BCG-unresponsive and BCG-exposed NMIBC.
- To assess prognostic differences across various types of BCG failure in NMIBC patients.
Main Methods:
- Analysis of a multicentre international cohort of 3806 BCG-treated patients.
- Inclusion of 591 patients with high-grade NMIBC recurrence after BCG (2003-2024).
- Primary endpoint: Progression-free survival (PFS); Secondary endpoints: Cancer-specific mortality (CSM) and overall mortality (OM).
Main Results:
- BCG-unresponsive and BCG-exposed NMIBC showed similar PFS, CSM, and OM.
- Prognosis varied significantly when stratified: 5-year progression rates ranged from 6.2% (BCG-resistant) to 32.5% (late relapse).
- Late relapse, BCG-exposed after inadequate BCG, and BCG-unresponsive were associated with higher progression risks compared to very late relapse.
Conclusions:
- Current IBCG definitions indicate similar poor outcomes for BCG-unresponsive and BCG-exposed NMIBC.
- A more refined classification highlights prognostic heterogeneity.
- Very late relapses after BCG confer a better prognosis than late relapses or BCG-unresponsive disease.
