A Retrospective Follow-up Study on the Effects ofDifferent Intravesical Treatments on Recurrence Controland Quality of Life in Patients WithNon-Muscle-Invasive Bladder Cancer AfterTransurethral Resection of Bladder Tumour

Background: This study aimed to compare the mid- to long-term effects of pirarubicin chemotherapy and Bacillus Calmette– Guérin (BCG) immunotherapy on recurrence control, bladder function and health-related quality of life in patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumour (TURBT). Methods: This retrospective cohort study comprised 126 patients with NMIBC who underwent TURBT followed by intravesical therapy between January 2018 and December 2023. Patients received either pirarubicin (n = 68) or BCG (n = 58). Propensity score matching was performed to reduce baseline imbalance, yielding 48 matched patients in each group. Recurrence outcomes, recurrence-free survival (RFS), bladder function parameters, quality-of-life scores and adverse events were compared. Results: After matching, the recurrence rate was lower in the BCG group than in the pirarubicin group (18.75% vs 37.50%, p = 0.041). Time to first recurrence was longer with BCG than with pirarubicin (28.47 ± 8.31 vs 20.96 ± 7.84 months, p = 0.016), and Kaplan–Meier analysis showed improved RFS (median RFS: 45 [34–56] vs 31 [22–40] months; log-rank p = 0.011). At 12 months, the BCG group had lower post-void residual urine volume, higher maximum urinary flow rate, higher European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Core 30 (QLQ-C30) global health and functional scores and lower symptom and Quality of Life Questionnaire-Bladder Cancer Module 30 (QLQ-BLM30) urinary symptom scores than the pirarubicin group (all p < 0.05). Subgroup analysis showed that the benefit of BCG was evident in patients with high-grade tumours. No severe treatment-related adverse events occurred in either group. Conclusions: In patients with NMIBC after TURBT, intravesical BCG was associated with better recurrence control and more favourable mid- to long-term functional and quality-of-life outcomes than pirarubicin, particularly in high-grade disease.