All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors

Kelly K. Bree, Patrick J. Hensley, Niyati Lobo, Nathan A. Brooks, Graciela M. Nogueras-Gonzalez, Charles C. Guo, Neema Navai, H. Barton Grossman, Colin P. Dinney, Ashish M. Kamat

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose:There is variation amongst guidelines with respect to risk stratification of Ta tumors, specifically high-grade (HG) Ta tumors. We sought to investigate the response of all Ta tumors to bacillus Calmette-Guérin (BCG) and compare response rates based on European Association of Urology (EAU) classification as intermediate- (IR) or high-risk (HR).Materials and Methods:An institutional review of all patients who received adequate BCG from 2000-2018 was conducted. EAU 2021 prognostic risk groups were used to stratify patients including by the newly proposed adverse risk factors.Results:When patient 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 number of EAU risk factors present (p=0.9, p=0.8 and p=0.9, respectively).Conclusions:All HG Ta tumors, regardless of EAU risk stratification, have inferior response to BCG and increased rates of progression compared to IR LG Ta tumors. EAU clinical risk factors did not improve prediction of oncologic outcomes among HG Ta patients who received adequate BCG. These data support consideration of all HG tumors as high risk.

Original languageEnglish
Pages (from-to)284-291
Number of pages8
JournalJournal of Urology
Issue number2
StatePublished - Aug 1 2022

Bibliographical note

Funding Information:
Support: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to AMK, and NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (Bladder) (P50CA091846) to CPND.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


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  • practice guideline [publication type]
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology


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