Urinary pH and oncologic outcomes after bacillus Calmette–Guérin in non–muscle invasive bladder cancer: A retrospective cohort study pH urinario y resultados oncológicos tras el tratamiento con bacilo de Calmette–Guérin en el cáncer de vejiga no músculo invasivo: un estudio de cohorte retrospectivo
Actas Urologicas Espanolas, cilt.50, sa.6, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 50 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.acuro.2026.501995
- Dergi Adı: Actas Urologicas Espanolas
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE, DIALNET
- Anahtar Kelimeler: Non-musde-invasive bladder cancer, Bacillus Calmette-Guerin, Urinary pH, Recurrence, Progression
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Urinary pH may influence intravesical Bacillus Calmette–Guérin (BCG) efficacy by modulating the local immune microenvironment. We evaluated baseline urinary pH as a continuous variable and its association with oncologic outcomes in BCG-treated non–muscle invasive bladder cancer (NMIBC). Methods: In this retrospective cohort, 248 NMIBC patients receiving adequate BCG therapy were analyzed. Recurrence-free survival (RFS) and progression-free survival (PFS) were assessed using Cox proportional hazards models. Given limited progression events, ridge (L2-penalized) multivariable regression was applied. Urinary pH was modeled per 1-unit increase and age per 10-year increment. Model discrimination was evaluated using Harrell's concordance index. Results: During follow-up, 43 patients (17.3%) developed recurrence and 28 (11.3%) experienced progression. In multivariable analysis, urinary pH was independently associated with improved RFS (HR 0.53, 95% CI 0.29–0.96, p = 0.035). For PFS, urinary pH showed a similar inverse direction but borderline significance after ridge adjustment (HR 0.69, 95% CI 0.48–1.00, p = 0.052). Concomitant carcinoma in situ and tumor stage remained independent predictors of progression. Model discrimination was good for RFS (C-index 0.713) and strong for PFS (C-index 0.841). Conclusions: Baseline urinary pH demonstrated an independent association with recurrence and a consistent directional association with progression in BCG-treated NMIBC. While dominant pathological features primarily determine progression risk, urinary pH may represent an accessible microenvironmental modifier of BCG responsiveness. Prospective validation is warranted.