當膀胱癌灌注治療面臨卡介苗中斷時以化療藥物作為的替代療法之預後

林柏廷、蘇世桓、張英勛¹、黃亮鋼、曲元正、甘弘成、林柏宏、虞凱傑、謝明里、莊正鏗、吳俊德²、馮思中、邵翊紘

林口長庚紀念醫院外科部 泌尿科系;

¹新北市立土城醫院 泌尿科系;

²基隆長庚紀念醫院外科部 泌尿科系

Outcomes of Chemotherapy Agents as Subsequent Replacements for Discontinued Bacillus Calmette-Guerin Bladder Instillation in Bladder Cancer

Po-Ting Lin, Shih-Huan Su, Ying-Hsu Chang¹, Liang-Kang Huang, Yuan-Cheng Chu, Hung-Chen Kan, Po-Hung Lin, Kai-Jie Yu, Ming-Li Hsieh, Cheng-Keng Chuang, Chun-Te Wu², See-Tong Pang, I-Hung Shao

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan;

Department of Urology¹, New Taipei Municipal TuCheng Hospital;

Division of Urology², Department of Surgery, Chang Gung Memorial Hospital, Keelong Branch, Taiwan

Purpose: To evaluate the efficacy of subsequent replacement with intravesical chemotherapy instillations in the patients with non-muscle-invasive bladder cancer (NMIBC), which had bladder instillation previously with bacillus Calmette-Guérin (BCG) but discontinued due to Global shortages and toxicity.

Materials and Methods: Patients newly diagnosed with NMIBC who received intravesical induction and/or maintenance instillation were retrospectively enrolled. Patients were divided into three groups according to different intravesical instillation schedules: [BCG only], [BCG + Chemo], and [Chemo only]. Comparisons between these three groups were performed. Bladder recurrence-free survival (RFS) was analysed as the primary endpoint.

Results: A total of 463 patients who received intravesical instillations were enrolled. The three groups had similar baseline characteristics, except [Chemo only] patients had a lower ratio of stage T1 disease. [BCG + Chemo] patients received significantly more total instillations than [BCG only] patients due to additional intravesical chemotherapy instillations (16.7 vs. 10.2, respectively). Compared to the [Chemo only] group, the [BCG + Chemo] group had significantly better bladder RFS (p value=0.034), while the [BCG only] group did not (p value=0.119).

Conclusion: For patients with intermediate- and high-risk NMIBC who have already received intravesical BCG instillations, subsequent replacement with chemotherapy agents is recommended if BCG is discontinued due to an unexpected shortage or intolerance.