非肌肉侵犯性膀胱癌行絲裂黴素及卡介苗灌注之比較:五年經驗
胡如娟、張瓈文、洪晟鈞、楊晨洸、李建儀、陳卷書、裘坤元、賀昊中、程千里、歐宴泉、王賢祥
臺中榮民總醫院泌尿外科
Bladder instillation with mitomycin or bacillus Calmette-Guérin in patients of non-muscle invasive bladder cancer: five years experiences at a single institution
Ju-Chuan Hu1, Li-Wen Chang1, Sheng-Chun Hung1, Cheng-Kuang Yang1, Jian-Ri Li1, Chuan-Shu Chen1,Kun-Yuan Chiu1, Hao-Chung Ho1,2, Chen-Li Cheng1, Yen-Chuan Ou3, Shian-Shiang Wang1
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung
2Division of Transplantation Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung
3Department of Urology, Tung’s Taichung MetroHarbor Hospital, Taichung
Purpose:
Current guideline recommended that postoperative bladder instillation with chemotherapy or bacillus Calmette-Guérin (BCG) should be provided to the patients with non-muscle invasive bladder cancer for the consideration to reduce the recurrences and to prevent or to delay disease progression to muscle-invasive bladder cancer. This study aims to evaluate the efficacy of bladder instillation with mitomycin (MMC) or BCG in patients with new diagnosis non-muscle invasive bladder cancer.
Materials and Methods:
From 2010 to 2015, 186 patients with new diagnosis of non-muscle invasive bladder cancer received transurethral resection of bladder cancer at Taichung Veterans General Hospital. After the procedure, immediate instillation with MMC was prescribed or not, depending on the surgical condition whether there were doubts of ruptured urinary bladder. About 3-4 weeks after the operation, induction therapy of weekly instillation with MMC or BCG for six weeks would be prescribed. Response and recurrence status would be evaluated. If upper tract urothelial carcinoma were found, radical nephroureterectomy with bladder cuff excision would be performed. The histological grading system was staged with WHO/ISUP grading system.
Results:
137 male patients and 49 female patients were enrolled in the analysis. There were 65 (55.1%)patients received immediate instillation with MMC and 28 (41.2%) patients with BCG. 117 patients received induction chemotherapy of MMC while the other 69 patients received induction immunotherapy of BCG. Immediate instillation showed longer medium recurrence-free survival time (67.82 months vs. 56.91 months, p = 0.023). The medium recurrence-free survival time in the patient with induction therapy of MMC and BCG was 58.92 months and 64.54 months (p = 0.23). Two patient in BCG group and seven patients in MMC group was found muscle invasion during follow-up. The medial progression-free survival between BCG and MMC were 90.71 months vs. 82.40 months. In patients with carcinoma in situ, there was significantly higher rate of recurrence and progression (p = 0.001), though BCG showed the better effect to prevent the recurrence but without significant benefit in preventing progression. The high-grade tumor appeared with poorer progression in compare with low-grade patients. A totally four patients with BCG infection were recorded.
Conclusion:
To our experience, immediate instillation after transurethral resection of bladder tumor is the crucial point for prevention of recurrence and muscle invasive progression. The efficacy of BCG induction is better than MMC instillation. However, the risks of BCG infection should be kept in mind.