Halstuch Daniel, Lotan Paz, Karchever Idan, Rubinshtein Dor, Kedar Daniel, Baniel Jack, Golan Shay
Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Genitourin Cancer. 2023 Oct;21(5):e320-e325. doi: 10.1016/j.clgc.2023.03.007. Epub 2023 Mar 23.
Perioperative instillation of mitomycin-C (MMC) has shown effectiveness in reducing the recurrence of low-grade non-muscle invasive bladder cancer (NMIBC). Data is lacking about the impact of single-dose MMC following office fulguration of low-grade urothelial carcinoma. We compared the outcomes of small-volume low-grade recurrent NMIBC in patients treated with office-fulguration - with and without an immediate single-dose instillation of MMC.
A retrospective analysis of medical records of patients with recurrent small-volume (≤1 cm) low-grade papillary urothelial cancer who underwent fulguration in a single institution between January 2017 and April 2021 either with or without instillation of post-fulguration MMC (40mg/50 mL). The primary outcome was recurrence-free survival (RFS).
Of 108 patients (27% women) who underwent fulguration, 41% received intravesical MMC. The treatment and control groups had similar sex ratio, mean age, mass size, tumor multifocality and or tumor grade. Median RFS was 20 months (95% CI 4-36) in the MMC group and 9 months (95% CI 5-13) in the control group (P = .038). Multivariate Cox regression analysis showed that MMC instillation was associated with longer RFS (OR = 0.552, 95% CI 0.320-0.955, P = .034) and multifocality was associated with shorter RFS (OR = 1.866, 1.078-3.229, P = .026). A higher rate of grade 1-2 adverse events was observed in the MMC group (18.2%) vs. the control (6.8%, P = .048). No complications grade 3 or higher were observed.
A single dose of MMC instilled after office fulguration is associated with longer RFS compared to patients who did not receive MMC after the procedure, with no associated high-grade complications.
围手术期灌注丝裂霉素C（MMC）已显示出在降低低级别非肌层浸润性膀胱癌（NMIBC）复发率方面的有效性。关于低级别尿路上皮癌经尿道电切术后单剂量MMC的影响的数据尚缺乏。我们比较了接受经尿道电切术治疗的小体积低级别复发性NMIBC患者的结局，这些患者在经尿道电切术时接受或未接受即时单剂量MMC灌注。
对2017年1月至2021年4月期间在单一机构接受经尿道电切术的复发性小体积（≤1 cm）低级别乳头状尿路上皮癌患者的病历进行回顾性分析，这些患者在经尿道电切术后被随机分组接受或未接受MMC（40mg/50 mL）灌注。主要结局是无复发生存期（RFS）。
在108例接受经尿道电切术的患者中（27%为女性），41%接受了膀胱内MMC灌注。治疗组和对照组在性别比例、平均年龄、肿块大小、肿瘤多灶性和肿瘤分级方面相似。MMC组的中位RFS为20个月（95%CI 4-36），对照组为9个月（95%CI 5-13）（P = 0.038）（此处原文有误，应为P=0.038）。多因素Cox回归分析显示，MMC灌注与更长的RFS相关（OR = 0.552，95%CI 0.320-0.955，P = 0.034），多灶性与更短的RFS相关（OR = 1.866，1.078-3.229，P = 0.026）。MMC组1-2级不良事件发生率较高（18.2%），而对照组为6.8%（P = .048）。未观察到3级或更高等级的并发症。
与术后未接受MMC的患者相比，经尿道电切术后单剂量MMC灌注与更长的RFS相关，且无相关的高级别并发症。 （注：译文括号内为对原文错误的说明，原文中部分统计值有误，实际应为P = 0.038 ）
