Gual Frau J, Palou J, Rodríguez O, Parada R, Breda A, Villavicencio H
Urology Service. Parc Taulí Sabadell. Hospital de Sabadell. Spain.
Urology Service. Fundació Puigvert. Barcelona. Spain.
Arch Esp Urol. 2016 Sep;69(7):423-33.
Adjuvant intravesical bacillus Calmette- Guérin (BCG) therapy is the standard conservative adjuvant treatment and the most effective regimen for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The term "BCG failure" is generally used to refer to recurrence or progression following BCG therapy, as experienced by many patients. However, the term has been defined inconsistently, and several studies have indicated that patients with a particular pattern of BCG failure have a worse prognosis. There are many different treatment options for patients who experience BCG failure.
To summarize the different current definitions of BCG failure and the present treatment options available for patients with high-risk NMIBC who experience BCG failure.
Overall, the failure rate in response to BCG is about 40-50%. Most guidelines recommend that patients failing BCG should be offered radical cystectomy (RC). The significant potential for progression specific to high-risk NMIBC leads some clinicians to argue that immediate RC should be considered the preferred first-line treatment in high-risk patients, bearing in mind that it achieves a long-term survival rate in excess of 90% with ongoing improvements in morbidity. While other salvage intravesical treatments have to be considered oncologically inferior to RC, several therapies are now available if the patient is unfit to undergo RC or if bladder preservation is the objective, and some agents have shown promise in the context of BCG failure.
The definition, prediction, and treatment of BCG failure remain topics of debate. Patients with BCG failure need carefully selected, individualized therapy in experienced hands. Stratification of patients with BCG failure into groups can identify those with a better or worse prognosis. RC should be the selected option if a patient experiences BCG failure, but several promising intravesical salvage options are available for those cases in which the patient is unfit for surgery or bladder preservation is preferred. Currently data are still inadequate to allow formulation of definitive recommendations, and larger and higher quality studies of salvage intravesical therapies are urgently required.
辅助性膀胱内卡介苗（BCG）治疗是高危非肌层浸润性膀胱癌（NMIBC）患者的标准保守辅助治疗及最有效的治疗方案。“卡介苗治疗失败”这一术语通常用于指许多患者在卡介苗治疗后出现的复发或进展情况。然而，该术语的定义并不一致，多项研究表明，具有特定卡介苗治疗失败模式的患者预后较差。对于经历卡介苗治疗失败的患者，有许多不同的治疗选择。
总结目前卡介苗治疗失败的不同定义以及针对经历卡介苗治疗失败的高危NMIBC患者的现有治疗选择。
总体而言，卡介苗治疗的失败率约为40% - 50%。大多数指南建议，卡介苗治疗失败的患者应接受根治性膀胱切除术（RC）。高危NMIBC特有的显著进展可能性使一些临床医生认为，对于高危患者，应将立即进行RC视为首选的一线治疗方法，要记住其长期生存率超过90%，且发病率在不断改善。虽然其他挽救性膀胱内治疗在肿瘤学上被认为不如RC，但如果患者不适合接受RC或目标是保留膀胱，现在有几种治疗方法可供选择，并且一些药物在卡介苗治疗失败的情况下已显示出前景。
卡介苗治疗失败的定义、预测和治疗仍是有争议的话题。卡介苗治疗失败的患者需要在经验丰富的医生手中接受精心挑选的个体化治疗。将卡介苗治疗失败的患者分层分组可以识别出预后较好或较差的患者。如果患者经历卡介苗治疗失败，RC应是首选方案，但对于那些患者不适合手术或更倾向于保留膀胱的情况，有几种有前景的膀胱内挽救性选择。目前的数据仍不足以制定明确的建议，迫切需要对挽救性膀胱内治疗进行更大规模、更高质量的研究。
