Lamm D L
Department of Urology, West Virginia University Health Sciences Center, Morgantown.
Urol Clin North Am. 1992 Aug;19(3):573-80.
Intravesical chemotherapy will cause complete regression of existing papillary tumor in one third to one half of patients. Controlled clinical trials have demonstrated that chemotherapy reduces the short-term incidence of tumor recurrence by 15% to 18%, but by 5 years, the number of patients suffering tumor recurrence is equal to that in patients treated with surgery alone. Tumor progression cannot occur in the absence of tumor recurrence, but existing studies of intravesical chemotherapy have failed to demonstrate significant reduction in disease progression or mortality rate with treatment. Immunotherapy has the advantage of a mechanism of action different from that of cytotoxic chemotherapy. Immunotherapy with BCG has resulted in complete tumor regression in one half or more of treated patients with papillary tumors and in more than 70% of those with CIS. Controlled studies similarly demonstrate a significant reduction in tumor recurrence, and protection from tumor recurrence has been observed to persist for 5 years or more. At the present time, data remain limited, but three controlled studies have found statistically significant reductions in the rate of disease progression, and one has found a significant reduction in the mortality rate, with BCG immunotherapy. These observations provide convincing evidence that immunotherapy is the treatment of choice for patients with aggressive superficial tumors and suggest that the development of immunotherapeutic alternatives to BCG is likely to be rewarding.
膀胱内化疗可使三分之一至一半的患者现有的乳头状肿瘤完全消退。对照临床试验表明，化疗可使肿瘤复发的短期发生率降低15%至18%，但到5年时，肿瘤复发患者的数量与仅接受手术治疗的患者数量相当。在没有肿瘤复发的情况下不会发生肿瘤进展，但现有的膀胱内化疗研究未能证明治疗能显著降低疾病进展或死亡率。免疫疗法的作用机制与细胞毒性化疗不同。用卡介苗进行免疫疗法已使一半或更多接受治疗的乳头状肿瘤患者以及超过70%的原位癌患者肿瘤完全消退。对照研究同样表明肿瘤复发显著减少，并且已观察到预防肿瘤复发可持续5年或更长时间。目前，数据仍然有限，但三项对照研究发现卡介苗免疫疗法使疾病进展率有统计学意义的显著降低，一项研究发现死亡率显著降低。这些观察结果提供了令人信服的证据，表明免疫疗法是侵袭性浅表肿瘤患者的首选治疗方法，并表明开发卡介苗的免疫治疗替代方法可能会有成效。
