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Those with metachronous NMIBC experienced poorer outcomes with BCG vs those with primary NMIBC.
Findings from systematic review of 7 cohort studies showed that patients with metachronous non–muscle-invasive bladder cancer (mNMIBC) experienced lower response rates to BCG compared with patients with primary de novo NMIBC (pNMIBC).1
Data presented at the 2026 Society of Urologic Oncology Annual Meeting demonstrated that across the 7 cohort studies, patients with pNMIBC experienced significantly longer recurrence-free survival (RFS) outcomes vs those with mNMIBC, with a 2-stage meta analysis yielding an HR of 0.44 (95% CI, 0.38-0.50; P < .001). Up to 55.9% of patients with mNMIBC experienced a high-grade RFS event vs up to 22.8% of patients with pNMIBC. A similar trend was observed in a 1-stage meta analysis (HR, 0.57; 95% CI, 0.46-0.71; P < .001).
Additionally, treatment with BCG was associated with improved progression-free survival (PFS) in patients with pNMIBC vs those with mNMIBC, with a 2-stage meta analysis, translating to an HR of 0.45 (95% CI, 0.22-0.90; P = .035). Up to 23.5% of patients with mNMIBC experienced disease progression to muscle-invasive bladder cancer (MIBC) or metastatic disease vs 9.8% of patients with pNMIBC. The 1-stage meta analysis revealed a similar trend (HR, 0.54; 95% CI, 0.35-0.83; P = .005).
A significant difference was not observed in terms of overall survival (OS) in the 2-stage meta analysis (HR, 0.88; 95% CI, 0.18-4.23; P = .751;), although a significant difference was seen in the 1-stage meta analysis (HR, 0.64; 95% CI, 0.56-0.73; P < .001). Lead study author Yu Guang Tan, MBBS, FAMS, and colleagues attributed the lack of a significant difference in the 2-stage analysis to short follow-up time frames in the cohort studies.
“Patients with mNMIBC exhibit a significantly poorer response to BCG compared [with] those with pNMIBC, with nearly double the rates of recurrence and disease progression,” Tan and colleagues wrote in a poster presentation of the data. Tan is an associate consultant in the Department of Urology at Singapore General Hospital.
Up to half of patients with upper tract urothelial carcinoma experience recurrence following treatment, defined as mNMIBC.1,2 Tan and colleagues explained that although risk stratification models such as European Organisation for Research and Treatment of Cancer (EORTC) and Club Urologico Espanol de Tratamiento Oncologico (CEUTO) can shed light on disease recurrence and progression in patients with bladder cancer, these models do not account for a history of upper tract urothelial carcinoma.1,3 They added that mNMIBC and pNMIBC have key differences in clinical and biological presentation.1
As such, investigators sought to evaluate outcomes for patients with high-grade NMIBC, including those with pNMIBC and those with mNMIBC after receiving prior treatment for upper tract urothelial carcinoma.
Investigators completed a comprehensive search of studies including patients with pNMIBC and mNMIBC, and the analysis included those with high-grade disease, excluding those with synchronous bladder cancer with upper tract urothelial carcinoma and those with low-grade disease.
Using 1- and 2-stage meta analyses, they looked at efficacy outcomes such as RFS, PFS, OS, and cancer-specific survival.
Pulling patient information from databases and registers, investigators identified 2728 studies from PubMed (n = 510), Embase (n = 1264), and Scopus (n = 954). After duplicate records (n = 669) were removed, 2050 of 2059 records were excluded. In the 9 remaining records that were assessed for eligibility, 2 were excluded due to featuring a MIBC cohort (n = 1) and not having extractable data for analysis (n = 1). Seven records were ultimately included in the meta analyses.
“Separate analysis of mNMIBC is warranted in clinical trials for better design, patient selection, and interpretation,” the study authors concluded.
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