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학술저널
저자정보
최세영 (중앙대학교) 하문수 (현대병원) 김정훈 (중앙대학교) 지병훈 (중앙대학교) 김진욱 (중앙대학교) 장인호 (중앙대학교) 김태형 (중앙대학교) 명순철 (중앙대학교)
저널정보
대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.63 No.2
발행연도
2022.3
수록면
140 - 150 (11page)
DOI
https://doi.org/10.4111/icu.20210340

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Purpose: Intravesical BCG (bacille Calmette?Guerin) instillation in patients with non-muscle-invasive bladder cancer decreases the risk for tumor recurrence and progression. After one BCG product was discontinued, a chronic global BCG shortage occurred. We focused on identifying a reduced dose of BCG that could maintain efficacy and reduce adverse effects. Materials and Methods: We conducted a comprehensive literature search of PubMed, Embase, the Cochrane Library, CINAHL, Web of Science, and Scopus to identify randomized controlled trials through April 2021. The odds ratios (ORs) and 95% confidence intervals (CIs) for the low and standard doses in nine studies were compared. A low dose was defined as a low volume of BCG compared with the standard BCG dose (Armand Frappier, 120 mg; Connaught, 81 mg; Danish 1331, 120 mg; modified Danish 1331, 120 mg; Tokyo 172, 80 mg). Results: The low-dose group experienced aggravated recurrence (OR, 1.45; 95% CI, 1.09?1.94; p=0.01) but similar progression (OR, 1.11; 95% CI, 0.76?1.62; p=0.59), similar cancer-specific survival (OR, 1.02; 95% CI, 0.60?1.75; p=0.93), similar overall survival (OR, 1.09; 95% CI, 0.76?1.56; p=0.65), favorable adverse effects (OR, 0.41; 95% CI, 0.28?0.62; p<0.0001), and favorable withdrawal (OR, 0.42; 95% CI, 0.25?0.71; p=0.001). Conclusions: Low-dose BCG had more unfavorable outcomes than did standard-dose BCG in terms of recurrence. Tumor progression, cancer-specific survival, and overall survival were similar between the doses. Low-dose BCG improved adverse effects and withdrawal. In the setting of BCG shortage, low-dose BCG may have strong potential as an alternative.

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