Filson Christopher P, Montgomery Jeffrey S, Dailey Stephen M, Crossley Heather S, Lentz Heidi, Tallman Christopher T, He Chang, Weizer Alon Z
Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
Urol Oncol. 2014 Jan;32(1):40.e1-8. doi: 10.1016/j.urolonc.2013.04.006. Epub 2013 Jun 17.
To better understand the risk of short-term complications associated with perioperative intravesical mitomycin-C (MMC) therapy for patients undergoing endoscopic management of non-muscle invasive bladder cancer.
Using an institutional database of patients with bladder cancer, we performed a retrospective case-control study of patients receiving perioperative MMC after tumor resection (2008-2012). MMC cases were matched by clinical stage to controls receiving endoscopic resection alone. Demographic information, clinicopathologic details, and outcomes were compared between groups. Outcomes of interest included overall, genitourinary, and major complications. Chi-square tests and multivariable logistic regression were used to evaluate associations among patient characteristics, clinical factors, exposure to MMC, and outcomes of interest.
One-hundred sixteen patients treated with MMC were matched to 116 controls. Patients receiving MMC were younger (P = 0.04) and more likely to have invasive disease (i.e. T1 or greater) (23% vs. 15%, P = 0.02). Complications were more frequent among patients who were treated with MMC (34.5% vs. 19.8%, Odds Ratio 2.89, 95% Confidence Interval 1.43-5.81). The most common complication among MMC patients that required medical management was dysuria (17%). Major complications were more common among MMC patients (5.2% vs. 0.9%), but this difference did not reach statistical significance (P = 0.11).
Use of MMC is associated with a greater odds of complications compared with controls. Patients should be counseled regarding both the benefits and potential risks of perioperative intravesical MMC. Continued research is required to understand the safety implications associated with the use of perioperative, intravesical MMC.
为了更好地了解接受非肌层浸润性膀胱癌内镜治疗的患者围手术期膀胱内注射丝裂霉素C（MMC）治疗相关的短期并发症风险。
利用一个膀胱癌患者的机构数据库，我们对肿瘤切除术后接受围手术期MMC治疗的患者（2008 - 2012年）进行了一项回顾性病例对照研究。MMC组病例根据临床分期与仅接受内镜切除的对照组进行匹配。比较两组之间的人口统计学信息、临床病理细节和结局。感兴趣的结局包括总体并发症、泌尿生殖系统并发症和主要并发症。采用卡方检验和多变量逻辑回归来评估患者特征、临床因素、MMC暴露与感兴趣结局之间的关联。
116例接受MMC治疗的患者与116例对照组患者进行了匹配。接受MMC治疗的患者更年轻（P = 0.04），且更有可能患有浸润性疾病（即T1期或更高分期）（23%对15%，P = 0.02）。接受MMC治疗的患者并发症更频繁（34.5%对19.8%，优势比2.89，95%置信区间1.43 - 5.81）。MMC组患者中需要药物治疗的最常见并发症是排尿困难（17%）。主要并发症在MMC组患者中更常见（5.2%对0.9%），但这种差异未达到统计学意义（P = 0.11）。
与对照组相比，使用MMC会增加并发症的发生几率。应向患者咨询围手术期膀胱内注射MMC的益处和潜在风险。需要继续开展研究以了解围手术期膀胱内注射MMC使用的安全性影响。
