非肌肉侵犯性膀胱癌行絲裂黴素及卡介苗灌注之比較:八年經驗
張瓈文 王賢祥 程千里 歐宴泉 賀昊中 裘坤元 陳卷書 李建儀 楊晨洸
台中榮民總醫院外科部泌尿外科
Bladder instillation with mitomycin or bacillus calmette-guérin in patients of non muscle invasive bladder cancer: eight years experiences
Li-Wen Chang, Shian-Shiang Wang , Chen-Li Cheng, Yen-Chuan Ou, Hao-Chung Ho, Kun-Yuan Chiu, Chuan-Shu Chen, Jian-Ri Li, Cheng-Kuang Yang,
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
Purpose:
To evaluation efficacy of bladder instillation with MMC or BCG in patients with new diagnosis non muscle invasive patient
Materials and methods:
From 2007 to 2015, a total 283 patients with new diagnosised non-muscle invasive bladder cancer receive transurethral resection of bladder cancer at our hospital. After procedure, immediate instillation with MMC was prescribed or not, depend on surgical condition whether there is doubt of bladder rupture. About 3-4 weeks after operation, induction therapy of weekly instillation with MMC or BCG for 6 weeks would be prescribed. Response and recurrence status would be evaluated. If upper tract urothelial carcinoma was found, radical nephrectomy with bladder cuff excision would be done. Histological grading system follow WHO/ISUP recommended grading system.
Results:
A total 220 male patients and 64 female patients were included. 145 patients ever received immediate instillation with MMC. 132 patients received induction chemotherapy of MMC and 89 patients received induction immunotherapy of BCG. In compare with immediate instillation or not, the medium recurrence free survival time was 67.82 months to 56.91 months (p = 0.023). The medium recurrence free survival time in patient with induction therapy of MMC and BCG were 58.92 months to 64.54 months (p = 0.23), respective. Two patient in BCG group and 7 patients in MMC group was found muscle invasion during clinical course. The medial progression free survival between BCG and MMC were 90.71 month vs. 82.40 months. In patients with CIS, there show a significant higher recurrence and progression rate (p = 0.001), though BCG showed better effect to prevent recurrence but no significant benefit in progression. High grade tumor appears poorer progression in compare with low grade patients. A totally 4 paitents with BCG infection were recorded.
Conclusion:
To our experience, immediate instillation after TURBt is the crucial point for prevent recurrence and muscle invasive progression. The efficacy of BCG induction is better than MMC instillation. However, risk of BCG infection should be bear in mind.