ReviewCancers2023
Efficacy of Different Bacillus of Calmette-Guérin (BCG) Strains on Recurrence Rates among Intermediate/High-Risk Non-Muscle Invasive Bladder Cancers (NMIBCs): Single-Arm Study Systematic Review, Cumulative and Network Meta-Analysis.
Review in Cancers, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic value of neutrophil to lymphocyte ratio for patients with bladder cancer undergoing radical cystectomy: a systematic review and meta-analysis.Frontiers in oncology · 2024Pooled it
- Beyond the BCG Paradox: Biological Rationale and Clinical Evidence for Combining Intravesical BCG with Immune Checkpoint Inhibitors in High-Risk Non-muscle-Invasive Bladder Cancer.Oncology and therapy · 2026Review
- Association Between Baseline Neutrophil-to-Lymphocyte Ratio and Short-Term Urinary Quality of Life During BCG Induction in Male Patients with Non-Muscle-Invasive Bladder Cancer: A Prospective Observational Study.Journal of clinical medicine · 2025Article
- Intravesical BCG therapy: implications for radiologists in abdominal imaging follow-up.Abdominal radiology (New York) · 2025Review
- Efficacy and safety of BCG and immune checkpoint inhibitors in non-muscle invasive bladder cancer: A meta-analysis with exploratory chemotherapy comparisons.Oncology letters · 2025Article
- Article
- Long-term efficacy of two sequential induction courses of Bacillus Calmette-Guérin in patients with high-risk non-muscle-invasive bladder cancer.Translational andrology and urology · 2025Article
- Retrospective, Non-Interventional, Multicenter Study on the Effectiveness and Safety of Intravesical Bacillus Calmette-Guerin in Patients with Non-Muscle-Invasive Bladder Cancer: Real-World Experience from Six Hospital Centers in Greece.Current oncology (Toronto, Ont.) · 2024Observational
- Chest wall tumor following intravesical BCG instillation for non-muscle invasive bladder cancer.Journal of clinical tuberculosis and other mycobacterial diseases · 2024Article
- Multi-omics analysis reveals that linoleic acid metabolism is associated with variations of trained immunity induced by distinct BCG strains.Science advances · 2024Article
- From plague to the promise: The journey of Bacille Calmette-Guérin.Bladder (San Francisco, Calif.) · 2024Article
- Emerging molecular therapies in the treatment of bladder cancer.Exploration of targeted anti-tumor therapy · 2024Review
- Article
- Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs.Frontiers in oncology · 2023Review
Corrections and comments
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Authors and funding
38 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn an era of Bacillus of Calmette-Guérin (BCG) shortages, the comparative efficacy from different adjuvant intravesical BCG strains in non-muscle invasive bladder cancer (NMIBC) has not been clearly elucidated. We aim to compare, through a systematic review and meta-analysis, the cumulative BC recurrence rates and the best efficacy profile of worldwide available BCG strains over the last forty years.
methodsPubMed, Scopus, Web of Science, Embase, and Cochrane databases were searched from 1982 up to 2022. A meta-analysis of pooled BC recurrence rates was stratified for studies with ≤3-y vs. >3-y recurrence-free survival (RFS) endpoints and the strain of BCG. Sensitivity analysis, sub-group analysis, and meta-regression were implemented to investigate the contribution of moderators to heterogeneity. A random-effect network meta-analysis was performed to compare BCG strains on a multi-treatment level.
resultsIn total, n = 62 series with n = 15,412 patients in n = 100 study arms and n = 10 different BCG strains were reviewed. BCG Tokyo 172 exhibited the lowest pooled BC recurrence rate among studies with ≤3-y RFS (0.22 (95%CI 0.16-0.28). No clinically relevant difference was noted among strains at >3-y RFS outcomes. Sub-group and meta-regression analyses highlighted the influence of NMIBC risk-group classification and previous intravesical treated categories. Out of the n = 11 studies with n = 7 BCG strains included in the network, BCG RIVM, Tice, and Tokyo 172 presented with the best-predicted probability for efficacy, yet no single strain was significantly superior to another in preventing BC recurrence risk.
conclusionWe did not identify a BCG stain providing a clinically significant lower BC recurrence rate. While these findings might discourage investment in future head-to-head randomized comparison, we were, however, able to highlight some potential enhanced benefits from the genetically different BCG RIVM, Tice, and Tokyo 172. This evidence would support the use of such strains for future BCG trials in NMIBCs.
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