Ma Chong, Zeng Shuxiong, Dai Lihe, Han Huan, Song Ruixiang, Xu Jinshan, Ai Xing, Xu Chuanliang
Department of Urology, The Third Medical Center of PLA General Hospital, Beijing, China.
Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
Asian J Urol. 2023 Jul;10(3):356-363. doi: 10.1016/j.ajur.2022.12.006. Epub 2023 Apr 14.
Bacillus Calmette-Guérin (BCG) instillation is the standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer after transurethral resection. Nevertheless, its toxicity often causes bladder complications. On follow-up cystoscopy, post-BCG bladder lesions can be pathologically benign, urothelial carcinoma recurrence, or other types of bladder malignancy. Only a small number of case reports have been published on post-BCG bladder lesions. Their clinical features, natural course, and management remain unknown.
We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center. During a long-term follow-up, we took biopsies on tumor-like lesions and described their changes. In addition, we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review.
We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years. Those lesions could last, grow, or disappear spontaneously, and remain pathological benign for years. In systematic review, we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information. Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type.
Based on previous studies and our experience, benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone, even under narrow band imaging mode. Nonetheless, given most of them have a good prognosis, random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.
卡介苗（BCG）膀胱灌注是经尿道切除术后中高危非肌层浸润性膀胱癌的标准辅助治疗方法。然而，其毒性常导致膀胱并发症。在随访膀胱镜检查中，卡介苗灌注后的膀胱病变在病理上可能是良性的、尿路上皮癌复发或其他类型的膀胱恶性肿瘤。关于卡介苗灌注后膀胱病变的病例报告仅有少数发表。其临床特征、自然病程及治疗方法仍不明确。
我们回顾性研究了本中心接受卡介苗治疗的膀胱癌患者的膀胱镜视频和病历。在长期随访过程中，我们对肿瘤样病变进行活检并描述其变化。此外，我们通过系统的文献检索和综述总结了既往关于卡介苗灌注后膀胱病变的研究。
我们描述了3例卡介苗灌注后膀胱病变类似肿瘤复发的病例，这些病例来自总共38例有5年以上随访数据的患者。这些病变可能持续、生长或自发消失，并在数年保持病理良性。在系统综述中，我们识别并分析了总共15例有详细临床信息的卡介苗灌注后膀胱病变病例。15例中有11例为良性，预后良好，其中肾源性腺瘤是最常见的病理类型。
根据既往研究和我们的经验，卡介苗灌注后的良性病变仅凭膀胱镜检查无法与癌症复发相区分，即使在窄带成像模式下也是如此。尽管如此，鉴于大多数良性病变预后良好，对于活检和尿液细胞学长期阴性的患者，可能无需进行随机活检或经尿道切除术。
