Tapiero Shlomi, Helfand Alexander, Kedar Daniel, Yossepowitch Ofer, Nadu Andrei, Baniel Jack, Lifshitz David, Margel David
Division of Urology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Urology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Urology. 2018 Aug;118:107-113. doi: 10.1016/j.urology.2018.04.039. Epub 2018 May 21.
To assess patient adherence to intravesical instillation therapy for nonmuscle invasive urothelial carcinoma outside of clinical trials.
We reviewed the records of patients from 2000 to 2013 who received intravesical therapy for nonmuscle invasive urothelial carcinoma. Patients with evidence of tumor recurrence or progression were excluded. We performed univariable and multivariable regression analyses to predict adherence to intravesical therapy.
A total of 729 patients started 861 induction cycles, 63% with bacillus Calmette-Guèrin (BCG) and 37% with mitomycin C (MMC). The rate of completion of 6 weeks induction therapy with BCG and MMC was similar (86% and 87%, respectively). Within the BCG cohort, 161 (35%) patients commenced the Southwest Oncology Group (SWOG) maintenance protocol after induction and 16 (10%) completed all 21 treatments. A monthly protocol for BCG was started by 87 patients (19%) and 48 (55%) completed all 9 treatments. MMC therapy was started in 270 patients, 97 of whom (36%) commenced monthly maintenance treatment, and 46 (47%) completed treatments. Median number of instillations was 7 for patients undergoing monthly maintenance therapy (MMC or BCG) and 9 for patients allocated to 3 years BCG. On multivariable analysis, recurrence after prior treatment of urothelial carcinoma was predictive of patients' adherence to treatment.
Compliance with intravesical therapy is low in clinical practice, notably for longer treatment schedules.
评估在临床试验之外，患者对非肌层浸润性尿路上皮癌膀胱灌注治疗的依从性。
我们回顾了2000年至2013年接受非肌层浸润性尿路上皮癌膀胱灌注治疗的患者记录。排除有肿瘤复发或进展证据的患者。我们进行了单变量和多变量回归分析以预测对膀胱灌注治疗的依从性。
共有729例患者开始了861个诱导周期，63%使用卡介苗（BCG），37%使用丝裂霉素C（MMC）。BCG和MMC的6周诱导治疗完成率相似（分别为86%和87%）。在BCG队列中，161例（35%）患者在诱导后开始了西南肿瘤协作组（SWOG）维持方案，16例（10%）完成了所有21次治疗。87例（19%）患者开始了BCG每月方案，48例（55%）完成了所有9次治疗。270例患者开始了MMC治疗，其中97例（36%）开始了每月维持治疗，46例（47%）完成了治疗。接受每月维持治疗（MMC或BCG）的患者灌注次数中位数为7次，分配接受3年BCG治疗的患者为9次。多变量分析显示，既往尿路上皮癌治疗后复发可预测患者对治疗的依从性。
在临床实践中，膀胱灌注治疗的依从性较低，尤其是对于较长的治疗方案。
