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8% to 45%, respectively,.35,36 The European Association of Urology (EAU) Guidelines recommend that all patients receive an immediate instillation of chemotherapy within 24?h after TUR.36 The choice between further intravesical chemotherapy or intravesical BCG is guided by the patient's risk of recurrence and progression to muscle invasive disease.35�C37 In patients at low risk of recurrence and progression (EORTC recurrence and progression scores?=?0), the http://www.selleck.cn/products/CAL-101.html probability of recurrence and progression at 1?year is 15% and 0.2%, respectively. In these patients, no further treatment after TUR is recommended before a further recurrence. In the intermediate-risk patients (intermediate or high risk of recurrence and intermediate risk of progression), the probability of recurrence and progression at 1?year is approximately 31% and 1%, respectively, whereas at 5?years it increases to approximately 54% and 6%, respectively. Thus, the main priority in these patients is to reduce the risk or recurrence; http://www.selleckchem.com/products/gsk2126458.html however, the risk of progression is not negligible. In the patients at the highest risk of progression (progression score 14�C23), the probability of progression within 1?year is 17% and increases to 45% at 5?years. In the high-risk patients, which includes patients with Ta/T1 high grade tumors and/or carcinoma in situ, the priority is clearly to prevent or at least reduce the incidence of progression to muscle invasive disease. Compared with TUR alone, meta-analyses have concluded that intravesical chemotherapy reduces the risk of recurrence;38�C41 however, there is no evidence that it also reduces the risk of progression to muscle invasive disease.38,42 Likewise, meta-analyses have also shown that intravesical BCG reduces the risk of recurrence compared with either TUR alone43,44 or to chemotherapy.45�C48 An individual patient data (IPD) meta-analysis comparing BCG with MMC clearly showed the necessity of giving maintenance when BCG is used. In the studies where patients received BCG maintenance, there was a 32% reduction in the risk of recurrence on BCG as compared with MMC (P? http://www.selleckchem.com/products/bay-57-1293.html both the patients previously treated and not previously treated with chemotherapy.48 Although somewhat controversial,49 there is now clear evidence that BCG reduces or at least delays the risk of progression to muscle invasive disease, but only when BCG maintenance is given.31,33,50 In a large meta-analysis of 4863 patients treated in 24 randomized studies where various treatment strategies were applied in the control group, BCG reduced the odds of progression by 27%, from 13.8% to 9.8% (OR?=?0.73, P?=?0.001), and by 37% when maintenance BCG of any duration was given (OR?=?0.63, P?=?0.00004).