J.A.Aichi Anjo Kosei Hospital, Japan
Takehiko Okamura has completed his doctorate in medical genetics in 1988 from Nagoya City University Medical School. From 1989 to 1991, he joined as research fellow at Department of Pathology and Microbiology, University of Nebraska Medical Center. He is a Chief Director of Department of Urology at J.A. Aichi Anjo Kosei Hospital. He has been continuing clinical and translational research about BCG more than 20 years, and has published more than 30 English papers in reputed journals.
The guidelines on the prophylactic use of Bacille Calmette-Guerin (BCG) against non-muscle-invasive bladder cancer change every few years. Here, we performed a retrospective comparison to clarify the differences in BCG efficacy by time period, focusing on a comparison between Japan and Western countries. A total of 146 patients with non-muscle-invasive bladder cancer that had been treated with BCG were evaluated. All patients received 80mg of BCG 6 to 8 times a week for prophylactic use. Three historical groups were compared: group A: 1980s, 39 cases; group B: 1990s, 61 cases; group C: 2000s, 46 cases. Internet searches were then performed to obtain information to compare Japanese and Western data. In total, recurrence was seen in 55 of the 146 cases (37.7%) and progression in 14 cases (9.6%). These results were similar to those described in previous reports. However, the outcomes of this time period-based analysis indicated a tendency for a shorter time to recurrence in patients treated after 2000, although showed no significance. These tendencies were similar with those in the Japanese literature; however, the recurrence-free rates of Western countries have been rather increasing yearly. The results of this study revealed a trend showing a low non-recurrence rate in our series and in other Japanese studies after 2000. However, these results were in conflict with Western data. This might stem from a number of factors, including changes in accepted BCG indications, introduction of re-TUR, the concept of BCG maintenance, and evolution of histopathological diagnostic criteria.