Chiancone Francesco, Fabiano Marco, Carrino Maurizio, Fedelini Maurizio, Meccariello Clemente, Fedelini Paolo
Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy.
Arab J Urol. 2021 Jan 13;19(1):86-91. doi: 10.1080/2090598X.2021.1874627.
: To evaluate the impact of pre- and post-treatment systemic inflammatory markers on the response to Hyperthermic IntraVEsical Chemotherapy (HIVEC) treatment in a cohort of patients with high-grade non-muscle-invasive bladder cancer with bacillus Calmette-Guérin (BCG) failure or intolerance who were unsuitable or unwilling to undergo early radical cystectomy. As a secondary endpoint, we assessed the influence of some demographic, clinical and pathological factors on the response to chemo-hyperthermia. : Between March 2017 and December 2019, 72 consecutive patients were retrospectively analysed. Patients with diseases or conditions that could interfere with systemic inflammatory status or full blood count were excluded. The HIVEC protocol consisted of six weekly intravesical treatments with 40 mg Mitomycin-C diluted in 50 mL distilled water. The drug was heated to a temperature of 43°C. Association of categorical variables with response to HIVEC was evaluated using Yates' chi-squared test and differences in continuous variable were analysed using the Mann-Whitney test. Logistic regression analysis was performed to define independent predictors of response to HIVEC. : Patients who failed HIVEC were more likely to have multiple tumours ( = 0.039) at transurethral resection of bladder and a recurrence rate of >1/year ( = 0.046). Lower post-HIVEC inflammatory indices [C-reactive protein ( = 0.021), erythrocyte sedimentation rate ( = 0.027)] and lower pre- ( = 0.014) and post-treatment ( = 0.004) neutrophil-to-lymphocyte ratio (NLR) values were significantly associated with the response to the HIVEC regimen (no bladder cancer recurrence or progression). In the multivariate analysis, patients with a recurrence rate of >1/year were eight-times more likely to experience failure of HIVEC ( = 0.007). Higher pre- ( = 0.023) and post-treatment NLR values ( = 0.046) were associated with a worse response to the HIVEC regimen. : The recurrence rate and systemic inflammatory response markers could be useful tools to predict the likelihood of obtaining a response with the HIVEC regimen. These markers might help to guide patients about the behaviour of the tumour after BCG failure, predicting failure or success of a conservative treatment. CHT: chemo-hyperthermia; CIS: carcinoma ; CRP: C-reactive protein; EAU: European Association of Urology; ESR: erythrocyte sedimentation rate; HG: high grade; HIVEC: Hyperthermic IntraVEsical Chemotherapy; ICD: immunogenic cell death; IL: interleukin; MMC: Mitomycin-C; NK: natural killer; NLR: neutrophil-to-lymphocyte ratio; NMIBC: non-muscle-invasive bladder cancer; PLR: platelet-to-lymphocyte ratio; RC: radical cystectomy; SIR: systemic inflammatory response; TURB: transurethral resection of bladder.
评估治疗前和治疗后全身炎症标志物对一组卡介苗(BCG)治疗失败或不耐受、不适合或不愿接受早期根治性膀胱切除术的高级别非肌层浸润性膀胱癌患者进行膀胱内热化疗(HIVEC)治疗反应的影响。作为次要终点,我们评估了一些人口统计学、临床和病理因素对热化疗反应的影响。:2017年3月至2019年12月,对72例连续患者进行回顾性分析。排除患有可能干扰全身炎症状态或全血细胞计数的疾病或状况的患者。HIVEC方案包括每周6次膀胱内治疗,将40mg丝裂霉素C稀释于50mL蒸馏水中。药物加热至43°C。使用Yates卡方检验评估分类变量与HIVEC反应的相关性,使用Mann-Whitney检验分析连续变量的差异。进行逻辑回归分析以确定HIVEC反应的独立预测因素。:HIVEC治疗失败的患者在膀胱经尿道切除术中更可能有多发肿瘤(P = 0.039)且复发率>1/年(P = 0.046)。HIVEC治疗后较低的炎症指标[C反应蛋白(P = 0.021)、红细胞沉降率(P = 0.027)]以及治疗前(P = 0.014)和治疗后(P = 0.004)较低的中性粒细胞与淋巴细胞比值(NLR)值与HIVEC方案的反应(无膀胱癌复发或进展)显著相关。在多变量分析中,复发率>1/年的患者HIVEC治疗失败的可能性高8倍(P = 0.007)。治疗前(P = 0.023)和治疗后较高的NLR值(P = 0.046)与HIVEC方案的较差反应相关。:复发率和全身炎症反应标志物可能是预测HIVEC方案反应可能性的有用工具。这些标志物可能有助于指导患者了解卡介苗治疗失败后肿瘤的行为,预测保守治疗的失败或成功。CHT:热化疗;CIS:癌;CRP:C反应蛋白;EAU:欧洲泌尿外科学会;ESR:红细胞沉降率;HG:高级别;HIVEC:膀胱内热化疗;ICD:免疫原性细胞死亡;IL:白细胞介素;MMC:丝裂霉素C;NK:自然杀伤细胞;NLR:中性粒细胞与淋巴细胞比值;NMIBC:非肌层浸润性膀胱癌;PLR:血小板与淋巴细胞比值;RC:根治性膀胱切除术;SIR:全身炎症反应;TURB:膀胱经尿道切除术