Kavoussi L R, Torrence R J, Gillen D P, Hudson M A, Haaff E O, Dresner S M, Ratliff T L, Catalona W J
Washington University School of Medicine, St. Louis, Missouri.
J Urol. 1988 May;139(5):935-40. doi: 10.1016/s0022-5347(17)42722-4.
We evaluated 104 patients with superficial bladder tumors for response to intravesical bacillus Calmett-Guerin therapy. Patients received 6 weekly intravesical bacillus Calmette-Guerin instillations and they were followed for response every 3 months with urinary cytology, cystoscopy and bladder biopsy. Patients were considered treatment failures if either the cytology studies or biopsies were positive for tumor. Of 65 patients who failed the initial treatment course 57 were given an additional 6-week course of therapy. One 6-week course of bacillus Calmette-Guerin was successful in 20 of 55 patients (36 per cent) treated for prophylaxis, 12 of 32 (37 per cent) treated for carcinoma in situ and 7 of 17 (41 per cent) treated for residual tumor. The response rate for the total patient population treated with 1, 6-week course was 37.5 per cent (39 of 104). A second 6-week course was successful in 19 of 29 patients (65 per cent) treated for prophylaxis, 11 of 18 (71 per cent) treated for carcinoma in situ and 4 of 10 (40 per cent) treated for residual tumor. The response rate for all patients receiving a second course of bacillus Calmette-Guerin was 59.6 per cent (34 of 57). Of 6 patients who refused another 6-week course of bacillus Calmette-Guerin 4 had additional recurrences and 3 of these 4 suffered invasive disease. The over-all therapeutic response rate for patients treated with either 6 or 12 weeks of therapy was 70 per cent. These results suggest that 6 weeks of intravesical bacillus Calmette-Guerin do not provide optimal therapy for superficial bladder tumors. The data further suggest that more intensive regimens may increase therapeutic efficacy.
我们评估了104例浅表性膀胱肿瘤患者对膀胱内卡介苗治疗的反应。患者接受每周1次、共6次的膀胱内卡介苗灌注，每3个月通过尿细胞学检查、膀胱镜检查和膀胱活检来随访反应情况。如果细胞学检查或活检显示肿瘤阳性，则患者被视为治疗失败。在65例初始治疗疗程失败的患者中，57例接受了额外的6周疗程治疗。1个6周的卡介苗疗程对55例接受预防性治疗的患者中的20例（36%）有效，对32例原位癌患者中的12例（37%）有效，对17例残留肿瘤患者中的7例（41%）有效。接受1个6周疗程治疗的全部患者的反应率为37.5%（104例中的39例）。第2个6周疗程对29例接受预防性治疗的患者中的19例（65%）有效，对18例原位癌患者中的11例（71%）有效，对10例残留肿瘤患者中的4例（40%）有效。接受第2个卡介苗疗程治疗的所有患者的反应率为59.6%（57例中的34例）。在6例拒绝接受另一个6周卡介苗疗程的患者中，4例出现了额外复发，这4例中的3例发生了浸润性疾病。接受6周或12周治疗的患者的总体治疗反应率为70%。这些结果表明，6周的膀胱内卡介苗治疗不能为浅表性膀胱肿瘤提供最佳治疗。数据进一步表明，更强化的治疗方案可能会提高治疗效果。
