High-grade Ta tumors unresponsive to BCG progress fast and may be classified as High risk

Recent research found that All HG Ta tumors have an inferior response to BCG and increased rates of progression and should be considered as high risk. The study was published in 'The Journal of Urology,2022.'

Guidelines differ concerning the risk stratification of Ta tumors, specifically high-grade (HG) Ta tumors. Hence researchers performed a study to investigate the response of all Ta tumors to bacillus Calmette-Guérin (BCG) and collate the response rates based on the European Association of Urology (EAU) classification, as intermediate- (IR) or high-risk (HR).

For this, researchers conducted an institutional review of all patients who received adequate BCG from 2000–2018. Later patients were stratified according to the EAU 2021 prognostic risk factors. The newly proposed adverse risk factors were also included.

Results:

• Patients with Ta tumors were stratified into IR and HR.
• 37 (16%) had IR low-grade (LG), Ta, 92 (40%) had IR HG Ta and 101 (44%) had HR HG Ta tumors.
• BCG unresponsiveness developed in 13% of HR HG Ta tumors and 14% of IR HG Ta tumors compared to 0.0% of IR LG Ta tumors (p=0.003).
• While no patients with IR LG Ta tumors progressed, progression rates were similar in HR HG Ta and IR HG Ta tumors (≥T2: 5.9% and 6.5%; T1: 13% and 13%, respectively).
• Rates of recurrence, BCG unresponsiveness, and progression were similar, irrespective of several EAU risk factors present (p=0.9, p=0.8, and p=0.9, respectively).

Thus, the researchers concluded that regardless of EAU risk stratification All HG Ta tumors have an inferior response to BCG and increased rates of progression compared to IR LG Ta tumors. They also added that as EAU clinical risk factors did not improve the prediction of oncologic outcomes among HG Ta patients who received adequate BCG, all HG tumors should be considered as high risk.

For the full article, click here: https://doi.org/10.1097/JU.0000000000002678

Bree KK, Hensley PJ, Lobo N, et al. All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors [published online ahead of print, 2022 Jun 30]. J Urol. 2022;101097JU0000000000002678.