Cochrane Unit, Research Department, Velindre NHS Trust, Whitchurch, Cardiff, Wales CF14 2TL, UK.
Cancer Treat Rev. 2010 May;36(3):195-205. doi: 10.1016/j.ctrv.2009.12.005. Epub 2010 Jan 15.
In 2002 there were estimated to be 357,000 new cases of bladder cancer worldwide and 145,000 deaths making bladder cancer the 9th most common malignancy globally. At diagnosis, 60-80% of tumours are superficial and endoscopic resection is the initial treatment for this disease. In patients with low, medium or high risk disease, about 20%, 40% and 90%, respectively, will develop tumour recurrence. To delay or prevent recurrence, intravesical therapy is routinely used. Commonly used intravesical agents include immunotherapy with BCG and chemotherapy with cytotoxics such as Mitomycin C, Adriamycin, Epirubicin and Gemcitabine. However, controversy exists as to which agent and schedule should be used.
An overarching search of the literature was used to identify relevant studies to assess the clinical benefit of intravesical therapy and provide clinical guidance in a comprehensive systematic review of randomised trials and meta-analyses of intravesical therapy for superficial bladder cancer. Findings and interpretation the search identified over 80 randomised trials and 11 meta-analyses. The extensive evidence suggests that an immediate post-operative instillation of a chemotherapeutic agent, such as Mitomycin C or Epirubicin, is effective in reducing tumour recurrence. In intermediate or high risk patients, further intravesical induction and maintenance therapy with BCG is recommended.
Intravesical chemotherapy with either Mitomycin C or Epirubicin would be an option for those patients failing or who are unsuitable for BCG therapy. Intravesical BCG is superior to chemotherapy in terms of complete response and disease-free survival. However, there is no conclusive evidence that one agent is superior in terms of overall survival.
2002 年，全球估计有 35.7 万例膀胱癌新发病例和 14.5 万例死亡病例，使膀胱癌成为全球第 9 大常见恶性肿瘤。在诊断时，60-80%的肿瘤为表浅性，内镜切除术是该疾病的初始治疗方法。在低危、中危或高危疾病患者中，分别约有 20%、40%和 90%会出现肿瘤复发。为了延缓或预防复发，常采用膀胱内治疗。常用的膀胱内药物包括卡介苗免疫治疗和丝裂霉素 C、阿霉素、表柔比星和吉西他滨等细胞毒性化疗药物。然而，对于应该使用哪种药物和方案存在争议。
采用全面文献检索来确定相关研究，以评估膀胱内治疗的临床获益，并在对膀胱内治疗浅表性膀胱癌的随机试验和荟萃分析的全面系统综述中提供临床指导。
检索确定了 80 多项随机试验和 11 项荟萃分析。大量证据表明，术后即刻膀胱内灌注化疗药物（如丝裂霉素 C 或表柔比星）可有效降低肿瘤复发率。在中危或高危患者中，建议进一步进行膀胱内诱导和维持治疗，使用卡介苗。
对于那些对卡介苗治疗无效或不适合卡介苗治疗的患者，膀胱内化疗（丝裂霉素 C 或表柔比星）是一种选择。在完全缓解和无病生存率方面，膀胱内卡介苗优于化疗。然而，没有确凿的证据表明一种药物在总生存率方面具有优势。
