針對非肌肉侵襲性膀胱癌使用卡介苗、排多癌及泛艾黴素行膀胱灌注之比較:
單一醫學中心之經驗
朱懿柏1 、吳子翔1、何肇晏1、林宜佳1,2、蔡德甫1,2、陳宏恩1、仇光宇1、鄭以弘1,2、
葉忠信1、莊光達1,2、黃一勝1,2
新光吳火獅紀念醫院 外科部 泌尿科1
輔仁大學 醫學系2
Comparison of intravesical Bacillus Calmetter‑Guerin, mitomycin C, and epirubicin instillation for non-muscle invasive bladder cancer: A single center experience
Yi-Bo Chu1, Tzu-Hsiang Wu1, Chao-Yen Ho1, Yi-Chia Lin 1,2, Te-Fu Tsai 1,2, Hung-En Chen1,
Kuang-Yu Chou1,2, Yi-Hung Cheng1, Chung-Hsin Yeh 1,2, Guang-Dar Juang 1,2、Thomas I.S. Hwang 1,2
Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital1
School of Medicine, Fu-Jen Catholic University2
Purpose:
The standard treatment for non-muscle invasive bladder cancer (NMIBC) is transurethral resection, followed by adjuvant intravesical instillation therapy. Intravesical instillation therapy has been used for the prophylaxis against tumor implantation after transurethral resection of bladder tumor (TUR-BT). This retrospective study was a comparison of intravesical therapy with Bacillus Calmetter-Guerin (BCG), mitomycin C (MMC), and epirubicin for NMIBC after TUR-BT.
Materials and Methods:
From March, 2009 to December 2015, 162 patients (mean age, 66.93±11.9 years) who received TURBT for NMIBC and then underwent intravesical therapy were identified retrospectively. The dosage of intravesical therapy of BCG, MMC, and epirubicin were 81mg, 30mg, and 50mg respectively. BCG was administered at least 1 week post-TUR-BT, and then weekly for 6 courses. MMC and Epirubicin were given after TUR-BT within 24 hours, and then once a week for 6 courses. A cystoscopy with/without urine cytology was employed for follow-up every 3 months. The demographic, 1-year recurrence rate, the interval of recurrence, and side effects were collected with a retrospective medical chart review.
Results:
Among the 162 patients, 45 patients received BCG, 62 patients received MMC, and 55 patients used epirubicin. The 1-year recurrence rate of BCG, MMC, and epirubicin stratified with the grading were 15% (CI: 3.8%-26.2%), 15.2% (CI: 6%-24.5%), and 37% (CI: 23.8%-50.65%) respectively (p<0.05). Multiple tumors and high grade of urothelial carcinoma were the risk factors of recurrence. The mean interval of recurrence of BCG, MMC, and epirubcin were 6.5 months, 7 months, and 6.9 months after the surgery (p= 0.95). The incidence of side effect was 31% in the BCG group, 19.3% in the MMC group, and 27.2% in the epirubicin group (p= 0.35). Among them, there were 10 patients (5 patients from BCG group, 3 patients from MMC group, and 2 patient from epirubicin group) who discontinued instillation therapy because of side effects.
Conclusion:
The result showed that BCG and MMC have superior prophylactic effect against tumor implantation than epirubicin in the patients with NMIBC. Increased recurrence rate was associated with multiple tumors and the grading of urothelial carcinoma. The side effects are higher in BCG group than MMC or epirubicin group, however statistical significance was not reached.