Lenis Andrew T, Asanad Kian, Blaibel Maher, Donin Nicholas M, Chamie Karim
David Geffen School of Medicine at the University of California Los Angeles, 300 Stein Plaza, Suite 348, Los Angeles, California, 90095, USA.
Department of Urology, Health Services Research Group, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
BMC Urol. 2018 Oct 24;18(1):93. doi: 10.1186/s12894-018-0408-6.
Intravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT.
We retrospectively reviewed records of patients with NMIBC at our institution in 2012-2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed.
205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28-6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20-0.59) and MMC (HR 0.43, 95% CI: 0.25-0.75) were associated with decreased risk.
Postoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone.
经尿道膀胱肿瘤切除术（TURBT）后膀胱内灌注丝裂霉素C（MMC）虽有效，但存在副作用且应用不佳。持续膀胱盐水灌注（CSBI）已被作为一种替代方法进行研究。在本研究中，我们试图比较非肌层浸润性膀胱癌（NMIBC）患者在TURBT后接受MMC或CSBI治疗后的复发率和/或进展率。
我们回顾性分析了2012年至2015年在我院就诊的NMIBC患者的病历。记录围手术期使用MMC（20 mL中含40 mg）、CSBI（两小时）或两者均未使用的情况。主要结局是复发或进展时间。进行了描述性统计、卡方分析、Kaplan-Meier生存分析和Cox多变量回归分析。
205例患者符合纳入标准。45例（22.0%）患者接受了CSBI，71例（34.6%）接受了MMC，89例（43.4%）未接受围手术期治疗。生存分析显示，与CSBI（p = 0.001）和未治疗（p = 0.0009）相比，MMC与无病生存期（DFS）改善相关。多变量分析显示，高危疾病与复发或进展风险增加相关（风险比[HR] 2.77，95%置信区间[CI]：1.28 - 6.01），而辅助治疗（HR 0.35，95% CI：0.20 - 0.59）和MMC（HR 0.43，95% CI：0.25 - 0.75）与风险降低相关。
与CSBI和未治疗相比，术后MMC与DFS改善相关。其他研究中CSBI所显示的DFS获益可能仅限于接受长时间灌注的患者。鉴于我们的数据表明短期CSBI并不优于单纯TURBT，正在评估的新膀胱内用药可能会考虑以盐水作为对照。
