膀胱BCG灌注對移植術後病人的效果及影響
黃烱焜1、黃子豪1,2,3、黃逸修1,2,3、張延驊1,2,3、鍾孝仁1,2,3、林登龍1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
Efficacy and complications of intravesical BCG in patients with Urothelial Carcinoma of Urinary Bladder after organ transplantation
Chiung-Kun Huang1 、Tzu-Hao Huang1,2,3 、Eric Yi-Hsiu Huang1,2,3, 、Yen-Hwa Chang1,2,3, 、Hsiao-Jen Chung1,2,3, 、Alex T.L. Lin1,2,3
Department of Urology, Taipei Veterans General Hospital1
Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan2
Purpose
Bacillus Calmette-Guérin (BCG) has been well recognized as the first line therapy for high risk Non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is considered to be contraindicated in immunosuppressed patients with bladder cancer because of the potential for the development of sepsis and the possibility that BCG may be ineffective in patients who cannot mount a robust immune response. We assessed the safety and efficacy of intravesical bacillus Calmette-Guerin instillations in patients underwent solid organ transplant with at least 1 induction along with 1 maintenance course.
Materials and Methods:
From 2001 to 2017, there are 4 patients diagnosed as bladder urothelial carcinoma after solid organ transplant in Taipei Veteran General Hospital. Intravesical BCG instillation was given for high risk patients according to AUA risk stratification. We retrospectively reviewed their immunosuppressive agent, initial tumor grading, treatment course, recurrence rate, side effects, disease free interval, and median follow-up months.
Results:
A total of 4 patients were included in the study. They treated with intravesical BCG as adjuvant therapy for high risk bladder cancer (3 CIS and 1 recurrent multiple pTa tumors). Bladder tumor occurred 1, 5, 8, 10 years after solid organ transplant (3 patient received kidney and 1 received liver transplant). The median age at transplant of the 3 patients was 46(range15-58). Three patients, received intravesical BCG after their initial diagnosis of bladder cancer for 12,12,15 courses, respectively. One patient, who was first incidentally diagnosed with left upper tract urothelial carcinoma after radical nephrectomy and partial ureterectomy for kidney empyema, had bladder cancer recurrence 32 months after the operation. TURBt was performed and followed by intravesical Mitomycin-C for pathologic grading of pTa for 9 courses. Bladder cancer recurred 8 months later, however, with multifocal pTa lesions >3cm. The patient then underwent right nephroureterectomy and left ureter stump excision with cystostomy bladder cuff excision. Intravesical BCG was applied for 12 courses. No specific local or systemic side effects was reported. The mean follow up period and recurrence free survival (RFS) were 36.75 months (range 12-93) in our series.
Conclusion:
Intravesical BCG induced immune response maybe effective for transplant patients under immunosuppressants in our series as compared to other reported studies. There are no specific BCG-related side effects in our series. The preliminary outcome of our series may reveal that standard BCG treatment for high-risk non-muscle invasive bladder cancer in these patients is a feasible option. Nevertheless, all of reported series, including ours, are all limited by lack of adequate case numbers. Further studies are required for reaching a more solid evidence in these special group of patients.