Gee Jason R, Jarrard David F, Bruskewitz Reginald C, Moon Timothy D, Hedican Sean P, Leverson Glen E, Nakada Stephen Y, Messing Edward M
Department of Urology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
BJU Int. 2009 Mar;103(6):736-9. doi: 10.1111/j.1464-410X.2008.08123.x. Epub 2008 Oct 31.
To evaluate the recurrence-free survival (RFS) rate of patients taking cardioprotective aspirin after intravesical bacille Calmette-Guérin (BCG) for high-grade noninvasive urothelial carcinoma of the bladder, as preventing the recurrence of superficial bladder cancer might decrease patient morbidity and mortality from this disease, and nonsteroidal anti-inflammatory agents (NSAIDs) have shown promise in preclinical prevention through inhibition of the prostaglandin pathway and other mechanisms.
In all, 43 patients with carcinoma in situ (CIS) and/or high-grade papillary bladder cancer were treated with intravesical BCG. Patients were stratified according to whether they took cardioprotective aspirin after treatment, and Kaplan-Meier curves of RFS were compared by log-rank analysis. Multivariable analysis was used for potentially confounding factors, including maintenance BCG, the presence of CIS, and smoking status.
Of patients taking cardioprotective aspirin, the 5-year RFS rate was 64.3%, compared with 26.9% for patients not taking aspirin, with a significantly higher RFS by univariable log rank analysis (P = 0.03). Even after adjusting for the other factors by multivariable analysis, aspirin seems to affect recurrence (hazard ratio 0.179, P = 0.001). Maintenance BCG (hazard ratio 0.233, P = 0.02) and smoking history (hazard ratio 3.199, P = 0.05) also significantly affected recurrence.
There was a significantly higher RFS rate in patients taking cardioprotective aspirin after intravesical BCG therapy for bladder cancer. The results of this study support the further investigation of aspirin and other NSAIDs as preventive agents in patients being treated for superficial bladder cancer.
评估接受卡介苗（BCG）膀胱灌注治疗的高级别非侵袭性膀胱尿路上皮癌患者服用心脏保护剂量阿司匹林后的无复发生存率（RFS），因为预防浅表性膀胱癌的复发可能会降低患者因该病导致的发病率和死亡率，且非甾体抗炎药（NSAIDs）已在临床前预防中通过抑制前列腺素途径及其他机制显示出前景。
共有43例原位癌（CIS）和/或高级别乳头状膀胱癌患者接受了BCG膀胱灌注治疗。根据治疗后是否服用心脏保护剂量阿司匹林对患者进行分层，并通过对数秩检验比较RFS的Kaplan-Meier曲线。对包括维持BCG灌注、CIS的存在及吸烟状况等潜在混杂因素进行多变量分析。
服用心脏保护剂量阿司匹林的患者，其5年RFS率为64.3%，未服用阿司匹林的患者为26.9%，单变量对数秩分析显示服用阿司匹林患者的RFS显著更高（P = 0.03）。即使在通过多变量分析对其他因素进行校正后，阿司匹林似乎仍会影响复发（风险比0.179，P = 0.001）。维持BCG灌注（风险比0.233，P = 0.02）和吸烟史（风险比3.199，P = 0.05）也显著影响复发。
膀胱癌患者接受BCG膀胱灌注治疗后服用心脏保护剂量阿司匹林的患者，其RFS率显著更高。本研究结果支持进一步研究阿司匹林及其他NSAIDs作为浅表性膀胱癌治疗患者预防药物的可能性。
