Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Research institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia.
Urol Oncol. 2020 Sep;38(9):737.e11-737.e16. doi: 10.1016/j.urolonc.2020.05.002. Epub 2020 Jul 5.
Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU.
Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis.
One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3-27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365).
I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.
单次术后膀胱内预防性化疗（pIVC）可有效降低根治性肾输尿管切除术（RNU）后膀胱癌的复发率。尽管有高水平的证据，但 pIVC 的使用率仍然较低。术中 pIVC（I-pIVC）可能比术后 pIVC（P-pIVC）更容易且更安全实施。我们旨在评估 RNU 期间 I-pIVC 的疗效。
回顾性分析了接受 RNU 并接受 20 至 40mg 丝裂霉素-C 或 1 至 2g 吉西他滨的 I-pIVC 或 P-pIVC 的患者。使用 Kaplan-Meier 曲线和对数秩检验评估复发率。使用单变量和多变量 Cox 回归进行分析。
最终分析纳入 137 例患者。81%（111/137）接受 I-pIVC，19%（26/137）接受 P-pIVC。在 I-pIVC 组中，HG、肌肉浸润性疾病和吉西他滨使用率较高。总体而言，137 例患者中有 74%（101/137）和 26%（26/137）接受了丝裂霉素-C 和吉西他滨灌注。在 12 个月内，137 例患者中有 14%（19/137）发生了膀胱复发。膀胱复发的中位时间为 7 个月（范围 3-27）。12 个月时膀胱无复发生存率分别为 I-pIVC 组 82%和 P-pIVC 组 72%（对数秩 P=0.365）。
RNU 期间 I-pIVC 可能降低膀胱复发率。膀胱复发率与术后灌注报道的结果相似。术中灌注可能更容易实施，并且可以提高使用率。
