Uchida Atsushi, Yonou Hiroyuki, Hayashi Eiri, Iha Kei, Oda Masami, Miyazato Minoru, Oshiro Yoshinori, Hokama Sanehiro, Sugaya Kimio, Ogawa Yoshihide
Department of Urology, University of the Ryukyus School of Medicine, Okinawa, Japan.
Urology. 2007 Feb;69(2):275-9. doi: 10.1016/j.urology.2006.10.017.
Frequent recurrence of superficial bladder cancer is a major problem that impairs patients' quality of life. We studied the current treatment of superficial bladder cancer, including the economic aspects of intravesical instillation.
A total of 138 superficial bladder cancers were assessed. The tumor characteristics and treatments were investigated during a mean observation period of 86 months by univariate and multivariate analyses. The costs associated with intravesical instillation of bacille Calmette-Guérin (BCG) and its side effects were subjected to cost-effectiveness analysis.
Tumor histologic examination revealed grade 1 in 21 lesions, grade 2 in 60 lesions, grade 3 in 40 lesions, and unclassified in 17 lesions. The pathologic stage was Stage Ta in 85 lesions, T1 in 47 lesions, and Tis in 6 lesions. Univariate and multivariate analyses showed that intravesical instillation of BCG was the most significant factor preventing recurrence, and intravesical chemotherapy had no impact on recurrence. The 5-year recurrence-free survival rate was 78% and 28% for tumors with and without BCG instillation, respectively. The cost-effectiveness ratio of BCG instillation was approximately 3900 dollars/5-yr recurrence-free period.
Our results have indicated that BCG is an effective adjuvant therapy after transurethral resection of superficial bladder cancer in the current medical environment.
浅表性膀胱癌的频繁复发是一个严重影响患者生活质量的主要问题。我们研究了浅表性膀胱癌的当前治疗方法，包括膀胱内灌注的经济方面。
共评估了138例浅表性膀胱癌。在平均86个月的观察期内，通过单因素和多因素分析研究了肿瘤特征和治疗方法。对卡介苗（BCG）膀胱内灌注的相关成本及其副作用进行了成本效益分析。
肿瘤组织学检查显示，21个病灶为1级，60个病灶为2级，40个病灶为3级，17个病灶未分类。病理分期为Ta期85个病灶，T1期47个病灶，Tis期6个病灶。单因素和多因素分析表明，BCG膀胱内灌注是预防复发的最显著因素，膀胱内化疗对复发无影响。接受和未接受BCG灌注的肿瘤5年无复发生存率分别为78%和28%。BCG灌注的成本效益比约为3900美元/5年无复发期。
我们的结果表明，在当前医疗环境下，BCG是经尿道切除浅表性膀胱癌后的一种有效辅助治疗方法。
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