Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
J Urol. 2011 Sep;186(3):817-23. doi: 10.1016/j.juro.2011.04.073. Epub 2011 Jul 23.
The unpredictable behavior of carcinoma in situ and its high potential for recurrence and progression make identifying patient characteristics predicting a poor prognosis a priority. We assessed which factors affect the response to bacillus Calmette-Guérin plus interferon-α therapy in patients with urothelial carcinoma in situ.
We analyzed data on a subset of 231 patients with carcinoma in situ enrolled in a multicenter, phase II trial of bacillus Calmette-Guérin plus interferon-α therapy for nonmuscle invasive bladder cancer. Analysis included patients who were bacillus Calmette-Guérin naïve and those with previous exposure to failed bacillus Calmette-Guérin therapy. We evaluated factors potentially affecting the bacillus Calmette-Guérin plus interferon-α response, including patient age, gender, tumor stage, multifocality, prior tumor stage, the previous bacillus Calmette-Guérin failure pattern, courses and maintenance, and prior chemotherapy.
The complete response rate at 3 and 6 months in naïve vs previously failed bacillus Calmette-Guérin cases was 76% and 70% vs 76% and 66%, respectively. The 24-month disease-free rate was decreased in the 53 patients with a history of 2 or more failed bacillus Calmette-Guérin courses vs that in the 71 with a history of 1 failed course and bacillus Calmette-Guérin naïve patients (23% vs 57% and 60%, respectively). The 22 patients with refractory carcinoma in situ had the worst outcome of a 23% disease-free rate at 24 months while the 59 with relapse within 1 year had an intermediate outcome of 42% vs 59% in the 33 with relapse after 1 year. Patients with a history of papillary disease did better than those without such a history (p=0.019).
Factors associated with a poor response to bacillus Calmette-Guérin plus interferon-α therapy in patients with carcinoma in situ are prior tumor stage, 2 or more prior bacillus Calmette-Guérin failures and a bacillus Calmette-Guérin failure pattern.
原位癌的不可预测行为及其高复发和进展的潜力使得确定预测预后不良的患者特征成为当务之急。我们评估了哪些因素会影响卡介苗加干扰素-α治疗在原位膀胱癌患者中的反应。
我们分析了一项卡介苗加干扰素-α治疗非肌肉浸润性膀胱癌的多中心二期试验中纳入的 231 例原位癌患者的亚组数据。分析包括卡介苗初治患者和卡介苗治疗失败的患者。我们评估了可能影响卡介苗加干扰素-α反应的因素，包括患者年龄、性别、肿瘤分期、多灶性、既往肿瘤分期、既往卡介苗失败模式、疗程和维持、既往化疗。
在初治与既往卡介苗治疗失败的病例中，3 个月和 6 个月时的完全缓解率分别为 76%和 70%、76%和 66%。在 53 例有 2 次或以上卡介苗治疗失败史的患者中，24 个月无病生存率较 71 例有 1 次卡介苗治疗失败史和卡介苗初治患者（23%对 57%和 60%）下降。22 例难治性原位癌患者的无病生存率最差，为 23%，24 个月时，59 例 1 年内复发患者的中间结局为 42%，33 例 1 年后复发患者的中间结局为 59%。有乳头状病变史的患者比没有乳头状病变史的患者预后更好（p=0.019）。
与卡介苗加干扰素-α治疗在原位癌患者中反应不良相关的因素是既往肿瘤分期、2 次或以上卡介苗治疗失败以及卡介苗失败模式。
