Luo Shuhang, Wu Yukun, Yang Rui, Huang Gaowei, Lei Jiahao, Liu Jinwen, Lin Shengjie, Chen Lingwu, Chen Junxing, Huang Bin
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, P.R.China; Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R.China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P.R.China.
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, P.R.China.
Urol Oncol. 2024 Feb;42(2):30.e9-30.e16. doi: 10.1016/j.urolonc.2023.09.018. Epub 2023 Oct 20.
To develop a novel combination therapy for high-risk nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT), namely, intra-arterial chemotherapy (IAC) plus BCG immunotherapy, and to compare the feasibility and safety of the 2 therapies.
A retrospective study was conducted on the data of 119 patients who were diagnosed with high-risk NMIBC and underwent TURBT in the past 5 years. Those who did not complete the treatment were excluded, and the remaining 98 patients were divided into 2 groups: both groups received intravesical BCG immunotherapy, while the BCG+IAC group received 4 courses of extra intra-arterial chemotherapy. Clinical and follow-up data were processed using statistical software.
The recurrence rate was 22.2% in the BCG+IAC group and 35.8% in the BCG group, whereas the progression rates were 8.9% and 24.5%, respectively. In the Kaplan-Meier plot, a statistically significant difference was observed with respect to recurrence-free survival (p = 0.025), as well as the progression-free survival of the two groups was similar (p = 0.019). A total of 22.2% of the patients with adverse effects of IAC and 79.6% of patients suffered from adverse reactions to BCG immunotherapy, and most of the adverse effects were mild and tolerable. Univariate and multivariate analysis indicated that multifocal and treatment were independent risk factors for recurrence, while the history of recurrence and treatment were independent risk factors for progression.
IAC could be a promising auxiliary treatment for BCG immunotherapy in decreasing the recurrence and progression rate of high-risk NMIBC with little additional toxicity.
开发一种用于高危非肌层浸润性膀胱癌（NMIBC）经尿道膀胱肿瘤切除术（TURBT）后的新型联合治疗方法，即动脉内化疗（IAC）联合卡介苗（BCG）免疫治疗，并比较这两种治疗方法的可行性和安全性。
对过去5年中被诊断为高危NMIBC并接受TURBT的119例患者的数据进行回顾性研究。排除未完成治疗的患者，其余98例患者分为2组：两组均接受膀胱内BCG免疫治疗，而BCG+IAC组接受4个疗程的额外动脉内化疗。使用统计软件处理临床和随访数据。
BCG+IAC组的复发率为22.2%，BCG组为35.8%，而进展率分别为8.9%和24.5%。在Kaplan-Meier曲线中，观察到两组无复发生存率有统计学显著差异（p = 0.025），且两组的无进展生存率相似（p = 0.019）。共有22.2%的患者出现IAC不良反应，79.6%的患者出现BCG免疫治疗不良反应，且大多数不良反应为轻度且可耐受。单因素和多因素分析表明，多灶性和治疗是复发的独立危险因素，而复发史和治疗是进展的独立危险因素。
IAC作为BCG免疫治疗的辅助治疗，在降低高危NMIBC的复发和进展率方面可能是一种有前景的方法，且几乎无额外毒性。
