Engeler Daniel S, Wyler Stephen, Neyer Michael, Hobi Christian, Müller Jurg, Schmid Hans-Peter
Department of Urology, St. Gallen Cantonal Hospital, Switzerland.
Scand J Urol Nephrol. 2008;42(6):522-7. doi: 10.1080/00365590802133099.
Early instillation chemotherapy (less than 6 h after tumour resection) is an accepted adjuvant treatment after transurethral resection of non-muscle-invasive papillary bladder tumours. Because most studies have reported on selected patients fulfilling specific eligibility criteria, this study investigated the feasibility of this therapy in a non-selected, consecutive series of patients who had undergone transurethral surgery to the bladder at a single institution.
All transurethral resections of the bladder were prospectively evaluated. In patients with assumed non-muscle-invasive papillary bladder cancer, resection was followed by early instillation of 50mg epirubicin. Practical problems, staging and cystoscopic follow-up were systematically registered and evaluated.
From October 2002 to February 2005, 210 transurethral resections (including 31 diagnostic biopsies) were performed in 163 patients (median age at resection 73.8 years). The following pathological T-stages were found: pT0 27.6%, pTa 39.0%, pT1 8.6%, > or =pT2 19.0% and pTis 5.7%. Patients received early instillation chemotherapy in 110 cases, which was generally well tolerated, but was prevented in four patients by intense bleeding or perforation. The treatment decision was correct in 82.8% and positively correlated with the experience of the treating urologist. Cumulative incidence rates of first postoperative tumour recurrence in the pTa group at 6, 12 and 24 months were 6.7, 24.5 and 52.0%, respectively.
Early instillation chemotherapy with epirubicin after transurethral resection of bladder tumours is generally feasible and usually has no major side-effects, but evaluation of intraoperative T-stage can be a problem and depends on experience.
早期灌注化疗（肿瘤切除后6小时内）是经尿道切除非肌层浸润性乳头状膀胱肿瘤后公认的辅助治疗方法。由于大多数研究报道的是符合特定入选标准的特定患者，本研究调查了在单一机构对一系列未经选择的、连续的接受膀胱经尿道手术的患者进行这种治疗的可行性。
对所有膀胱经尿道切除术进行前瞻性评估。对于假定为非肌层浸润性乳头状膀胱癌的患者，切除术后早期灌注50mg表柔比星。系统记录并评估实际问题、分期及膀胱镜随访情况。
2002年10月至2005年2月，163例患者（切除时中位年龄73.8岁）接受了210次经尿道切除术（包括31次诊断性活检）。病理T分期如下：pT0为27.6%，pTa为39.0%，pT1为8.6%，≥pT2为19.0%，pTis为5.7%。110例患者接受了早期灌注化疗，总体耐受性良好，但4例患者因严重出血或穿孔而未进行。治疗决策正确的比例为82.8%，且与治疗泌尿外科医生的经验呈正相关。pTa组术后6个月、12个月和24个月首次肿瘤复发的累积发生率分别为6.7%、24.5%和52.0%。
膀胱肿瘤经尿道切除术后早期灌注表柔比星化疗总体可行，通常无严重副作用，但术中T分期的评估可能存在问题，且取决于经验。
