Yildiz Ali Kaan, Bayraktar Arif, Kacan Turgay, Demir Demirhan Orsan, Gokkurt Yusuf, Erbay Omer Furkan, Keseroglu Bugra Bilge, Ozgur Berat Cem, Doluoglu Omer Gokhan, Karakan Tolga
Department of Urology, University of Health Sciences, Ankara City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, 06800, Ankara, Turkey.
Department of Urology, Ankara City Hospital, Ankara, Turkey.
Int Urol Nephrol. 2025 Aug 28. doi: 10.1007/s11255-025-04767-w.
To evaluate different protocols to increase the efficacy and reliability of single, immediate intravesical postoperative chemotherapy (IPOC) after transurethral bladder tumour resection (TURBT).
A retrospective evaluation was made of 104 patients, who underwent TURBT between October 2020 and October 2022, and were subsequently administered IPOC. The patients were examined in two groups as infusion IPOC (n:50) and bolus IPOC (n:54). In the infusion IPOC group, 50 mg epirubicin in 100 mL saline was administered intravesically in 30 min as an infusion with gravity. In the bolus IPOC group, 50 mg epirubicin in 50 mL saline was administered intravesically as a bolus with a catheter-type syringe. Preoperative information was recorded, including age, gender, body mass index (BMI), ASA score, smoking status, primary tumour, and previous IPOC, and postoperative information, including number, size, stage, and grade of tumour, the presence of detrusor muscle in the specimen, prognostic risk group, and second TURB. The two groups were compared with respect to dysuria, urgency, pain (VAS score), IPOC discontinuation, tumour recurrence rate, and recurrence-free survival (RFS).
No statistically significant difference was determined between the groups with respect to age, gender, BMI, ASA score, smoking status, presence of primary tumour, number and size of tumours, the presence of detrusor muscle in the specimen, stage and grade of tumour, prognostic risk group, second TURB, and previous IPOC (p > 0.05 for all). The VAS score for pain/bladder irritation was determined to be statistically significantly lower at 2.3 ± 1.8 in the infusion IPOC group compared to 3.1 ± 2.2 in the bolus IPOC group (p = 0.01). The discontinuation rate of 10.0% was statistically significantly lower in the infusion IPOC group compared to the 25.9% rate determined in the bolus group (p = 0.04). Although the RFS rate was higher in the infusion IPOC group in all the NMIBC patients (p = 0.4) and in the low-risk NMIBC subgroup (p = 0.1), no significant difference was found. In the low-risk NMIBC, the 3-month recurrence rate was 3.3% in the infusion IPOC group and 20.5% in the bolus group, and thus the infusion protocol was observed to have significantly reduced early recurrence (p = 0.04).
The results of this study showed that an infusion IPOC protocol demonstrated reliability, efficacy, and applicability, which decreased bladder irrigation and treatment discontinuation rates while also reducing early recurrence.
评估不同方案，以提高经尿道膀胱肿瘤切除术（TURBT）后单次即时膀胱内术后化疗（IPOC）的疗效和可靠性。
对2020年10月至2022年10月期间接受TURBT并随后接受IPOC的104例患者进行回顾性评估。将患者分为两组，即灌注IPOC组（n = 50）和推注IPOC组（n = 54）。在灌注IPOC组中，将100 mL盐水中的50 mg表柔比星以重力输注的方式在30分钟内膀胱内给药。在推注IPOC组中，将50 mL盐水中的50 mg表柔比星用导管式注射器以推注的方式膀胱内给药。记录术前信息，包括年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）评分、吸烟状况、原发性肿瘤和既往IPOC，以及术后信息，包括肿瘤的数量、大小、分期和分级、标本中逼尿肌的存在、预后风险组和二次TURBT。比较两组在排尿困难、尿急、疼痛（视觉模拟评分[VAS]）、IPOC中断、肿瘤复发率和无复发生存期（RFS）方面的情况。
两组在年龄、性别、BMI、ASA评分、吸烟状况、原发性肿瘤的存在、肿瘤的数量和大小、标本中逼尿肌的存在、肿瘤的分期和分级、预后风险组、二次TURBT和既往IPOC方面均未发现统计学上的显著差异（所有p>0.05）。与推注IPOC组的3.1±2.2相比，灌注IPOC组疼痛/膀胱刺激的VAS评分在统计学上显著更低，为2.3±1.8（p = 0.01）。灌注IPOC组10.0%的中断率在统计学上显著低于推注组确定的25.9%的中断率（p = 0.04）。虽然在所有非肌层浸润性膀胱癌（NMIBC）患者中灌注IPOC组的RFS率更高（p = 0.4），在低风险NMIBC亚组中也是如此（p = 0.1），但未发现显著差异。在低风险NMIBC中，灌注IPOC组的3个月复发率为3.3%，推注组为20.5%，因此观察到灌注方案显著降低了早期复发率（p = 0.04）。
本研究结果表明，灌注IPOC方案具有可靠性、有效性和适用性，可降低膀胱冲洗和治疗中断率，同时减少早期复发。
