Department of Urology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Road, Longhua District, Haikou, 570311, China.
Department of Nursing, Haikou Fourth People's Hospital, No. 65, Yehai Road, Qiongshan District, Haikou, 571100, China.
Lasers Med Sci. 2020 Oct;35(8):1695-1701. doi: 10.1007/s10103-020-02960-0. Epub 2020 Jan 22.
The objective of this study was to evaluate which patients might benefit from a single immediate postoperative intravesical instillation (SII) compared to maintenance intravesical instillations (MII) in primary non-muscle-invasive bladder cancer (NMIBC) after transurethral en bloc resection of bladder tumors (ERBT). A total of 141 patients with primary NMIBC who underwent ERBT with thulium laser between January 2012 and May 2016 were retrospectively enrolled. All the patients were categorized into two groups based on the duration of postoperative intravesical instillation of pirarubicin (THP): single intravesical instillation (SII) group, patients received a single immediate postoperative intravesical instillation of THP (30 mg), and maintenance intravesical instillations (MII) group, patients received a 1-year MII of THP (30 mg). Prognosis and recurrence data of each group were analyzed. One hundred and four (73.8%) patients received MII, and other 37 (26.2%) patients received SII. There was no significant difference in recurrence-free survival (RFS) between the two groups (P = 0.105). Following recurrence risk-stratified analysis, patients with high recurrence risk who accepted SII had a significantly lower RFS rate than those who received MII (P = 0.027). However, there were no significant differences in RFS rate between the two groups in patients with low and intermediate recurrence risk. In the multivariate analysis, the number of tumors was found to be an independent prognostic factor for RFS in NMIBC patients [hazard ratio, 5.665; 95% confidence interval (CI), 2.577-12.454; P < 0.001]. SII seems not to be inferior to MII in patients with initial low-risk and intermediate-risk NMIBC after ERBT.
本研究旨在评估在经尿道整块切除术（ERBT）治疗原发性非肌肉浸润性膀胱癌（NMIBC）后，与维持性膀胱内灌注（MII）相比，哪些患者可能从单次即刻术后膀胱内灌注（SII）中获益。
回顾性纳入了 2012 年 1 月至 2016 年 5 月期间接受钬激光 ERBT 治疗的 141 例原发性 NMIBC 患者。所有患者均根据术后吡柔比星（THP）膀胱内灌注时间分为两组：单次膀胱内灌注（SII）组，患者接受单次即刻术后膀胱内灌注 THP（30mg）；维持性膀胱内灌注（MII）组，患者接受 1 年 THP（30mg）MII。分析各组的预后和复发数据。104 例（73.8%）患者接受 MII，37 例（26.2%）患者接受 SII。两组无复发生存率（RFS）无显著差异（P=0.105）。
在复发风险分层分析后，接受 SII 的高复发风险患者的 RFS 率显著低于接受 MII 的患者（P=0.027）。然而，在低复发风险和中复发风险患者中，两组的 RFS 率无显著差异。多变量分析显示，肿瘤数量是 NMIBC 患者 RFS 的独立预后因素[风险比，5.665；95%置信区间（CI），2.577-12.454；P<0.001]。对于初始低危和中危 NMIBC 患者，SII 似乎并不逊于 MII。
