Okamura Takehiko, Akita Hidetoshi, Tozawa Keiichi, Kawai Noriyasu, Nagata Daisuke, Kohri Kenjiro
The Urology Division, Meijo Hospital, 1-3-1 San-nomaru, Naka-ku, Nagoya 460-0001, Japan.
Int J Clin Oncol. 2003 Jun;8(3):168-73. doi: 10.1007/s10147-003-0323-y.
Reasons for development of bacillus Calmette-Guerin(BCG)-refractory superficial bladder cancers are unknown. In the present study, a series of cases was therefore analyzed, focusing on the influence of treatment before BCG application.
A total of 96 patients with superficial bladder cancers received six weekly intravesical instillations of BCG followed in some cases by a further six applications at monthly intervals. If tumors recurred, a further course of treatment in association with surgery or some other therapy was chosen, depending on the patient and the tumor condition.
Thirty-three cases (34.4%) demonstrated tumor recurrence within 24 to 146 months, including 9 with progression. Pretreatments had been performed in 19 of these cases (57.6%) whereas they had been conducted for only 10 (15.9%) of the BCG-effective cases. Of the total 96 patients, 29 received pretreatment with open surgery, systemic chemotherapy, intravesical instillation or oral administration of anticancer drugs, or immunotherapy. Sixty-six percent of these proved BCG refractory, in contrast to only 20.9% in the no-pretreatment group. Furthermore, 7 of the 9 patients demonstrating progression had undergone pretreatment.
The data suggest that intravesical instillation of BCG is more effective when no prior treatment has been attempted, and that best results may be achieved if BCG is chosen as the initial therapy for superficial bladder cancer. When pretreatment has been performed and pT1 lesions recur, however, immediate total cystectomy should be advised.
卡介苗（BCG）难治性浅表性膀胱癌的发病原因尚不清楚。因此，在本研究中，我们分析了一系列病例，重点关注卡介苗应用前治疗的影响。
共有96例浅表性膀胱癌患者接受了每周一次、共6次的卡介苗膀胱内灌注，部分患者随后每月再进行6次灌注。如果肿瘤复发，则根据患者和肿瘤情况选择与手术或其他治疗联合的进一步治疗方案。
33例（34.4%）患者在24至146个月内出现肿瘤复发，其中9例出现进展。这些复发患者中有19例（57.6%）在卡介苗治疗前接受过其他治疗，而卡介苗治疗有效的患者中只有10例（15.9%）接受过治疗。在96例患者中，29例接受过开放手术、全身化疗、膀胱内灌注或口服抗癌药物或免疫治疗等预处理。这些患者中66%的人对卡介苗治疗无效，而未接受预处理的患者中这一比例仅为20.9%。此外，9例出现进展的患者中有7例接受过预处理。
数据表明，在未进行过先前治疗时，膀胱内灌注卡介苗更有效，并且如果将卡介苗作为浅表性膀胱癌的初始治疗方法，可能会取得最佳效果。然而，当进行过预处理且pT1病变复发时，建议立即进行全膀胱切除术。
