Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
BMC Nephrol. 2020 Oct 7;21(1):426. doi: 10.1186/s12882-020-02073-4.
Bladder cancer is the most common malignant tumor of the urinary system. One of the biological characteristics of NMIBC is the high recurrence rate after surgery. The implementation of this project aimed to investigate the role of pharmacogenomic testing-guided intravesical perfusion of chemotherapeutic agents in the postoperative perfusion therapy for non-muscle invasive bladder cancer.
From January 2015 to December 2016, 298 patients with non-muscle-invasive bladder cancer were enrolled in this prospective study. These patients received chemotherapy drugs after electrotherapy. According to the presence or absence of tumor susceptibility gene detection after surgery, they were divided into two groups, including the drug sensitive group(N = 44) and the control group(N = 254). The drug sensitive group received bladder infusion therapy with sensitive chemotherapy drugs based on drug sensitivity gene detection results. The control group received intravesical instillation of pirarubicin. The preoperative general data and tumor grade of patients were recorded. Cystoscopy was performed before and every 3 months after surgery. The chest CT, upper abdomen CT, renal function, and urinary routine tests were performed. Tumor recurrence, metastasis and tumor-related death were recorded and evaluated during follow-up.
The drug sensitive group, which selected high-sensitivity drugs for intravesical instillation therapy based on gene expression, has a significantly lower relapse rate (11.36% vs 37.40%, P < 0.05) and a significantly longer time to relapse (17.80 ± 7.20 month vs11.20 ± 6.10 month, P < 0.05) compared with the control group. There were no significant differences in the time of mortality and death time between two groups.
The pharmacogenomic testing-directed bladder instillation of chemotherapeutic drugs may be more effective than empiric drug administration in reducing the recurrence rate of non-muscle-invasive bladder cancer.
膀胱癌是泌尿系统最常见的恶性肿瘤。非肌层浸润性膀胱癌（NMIBC）的生物学特征之一是手术后复发率高。本项目旨在探讨药物基因组检测指导下膀胱内灌注化疗药物在非肌层浸润性膀胱癌术后灌注治疗中的作用。
本前瞻性研究于 2015 年 1 月至 2016 年 12 月纳入 298 例非肌层浸润性膀胱癌患者。这些患者在电疗后接受化疗药物治疗。根据术后是否进行肿瘤易感性基因检测，将其分为药物敏感组（N=44）和对照组（N=254）。药物敏感组根据药物敏感基因检测结果，采用敏感化疗药物进行膀胱灌注治疗。对照组给予吡柔比星膀胱灌注。记录患者术前一般资料及肿瘤分级，术后每 3 个月行膀胱镜检查，定期行胸部 CT、上腹部 CT、肾功能、尿常规检查。随访期间记录并评估肿瘤复发、转移及肿瘤相关死亡情况。
药物敏感组根据基因表达选择高敏药物进行膀胱内灌注治疗，复发率（11.36%比 37.40%，P<0.05）明显降低，复发时间（17.80±7.20 月比 11.20±6.10 月，P<0.05）明显延长，与对照组比较差异有统计学意义。两组患者的死亡时间和死亡率差异无统计学意义。
药物基因组检测指导下的膀胱内灌注化疗药物可能比经验性药物治疗更有效地降低非肌层浸润性膀胱癌的复发率。
