Pansadoro V, Emiliozzi P, depaula F, Scarpone P, Pizzo M, Federico G, Martini M, Pansadoro A, Sternberg C N
Vincenzo Pansadoro Foundation and San Giovanni Hospital, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):223-7.
Immunotherapy with Bacillus Calmette Guerin (BCG) has been widely used recently as primary option for treatment of high grade superficial (G3T1) carcinoma of the bladder. We describe our long term experience of therapy of G3T1 bladder cancer.
From January 1982 to December 2000, 785 patients were diagnosed with superficial bladder cancer. All patients underwent preoperative CT scan and transurethral resection of the bladder. Eighty-six patients (11%) had histological high grade superficial bladder cancer infiltrating the lamina propria. This group was treated with the following schedule of BCG Pasteur strain plus maintenance. Four cycles BCG, 6 instillations per cycle, first cycle weekly x 6, second cycle every 2 weeks x 6, third cycle monthly x 6, fourth cycle (maintenance) every 3 months x 6 instillations.
The median follow-up is 91 months (30-197 months). The overall recurrence rate was 35% (30/86). The median time to recurrence was 29 months (5-128 months). Of these patients, 12 (14%) had progression at a median follow-up of 16 months (range 8-58 months). Cystectomy was needed in 8 (9%) patients. Death due to disease occurred in 5/86 (6%) patients. One patient died due to adenocarcinoma at the ureterosigmoidostomy site. Sixty-four (74%) patients are alive at a median follow-up of 71 months (range 28-197 months). Sixty patients (70%) are alive with an intact bladder.
Treatment with BCG is a feasible conservative therapy for patients with primary G3T1 transitional bladder cancer. Long term results of BCG treatment are excellent. Cystectomy shouldn't be considered first line treatment for high grade superficial carcinoma of the bladder.
卡介苗（BCG）免疫疗法近来已被广泛用作治疗高级别浅表性（G3T1）膀胱癌的主要选择。我们描述了我们治疗G3T1膀胱癌的长期经验。
1982年1月至2000年12月，785例患者被诊断为浅表性膀胱癌。所有患者均接受了术前CT扫描和经尿道膀胱切除术。86例（11%）患者患有浸润固有层的组织学高级别浅表性膀胱癌。该组患者接受了以下卡介苗巴斯德菌株治疗方案并进行维持治疗。四个周期的卡介苗治疗，每个周期6次灌注，第一个周期每周1次，共6次；第二个周期每2周1次，共6次；第三个周期每月1次，共6次；第四个周期（维持）每3个月1次，共6次灌注。
中位随访时间为91个月（30 - 197个月）。总复发率为35%（30/86）。复发的中位时间为29个月（5 - 128个月）。在这些患者中，12例（14%）在中位随访16个月（范围8 - 58个月）时出现病情进展。8例（9%）患者需要进行膀胱切除术。86例中有5例（6%）患者死于疾病。1例患者死于输尿管乙状结肠吻合口处的腺癌。64例（74%）患者在中位随访71个月（范围28 - 197个月）时仍存活。60例（70%）患者存活且膀胱完整。
对于原发性G3T1移行性膀胱癌患者，卡介苗治疗是一种可行的保守治疗方法。卡介苗治疗的长期效果良好。膀胱切除术不应被视为高级别浅表性膀胱癌的一线治疗方法。
