The optimal intravesical maintenance chemotherapy scheme for the intermediate-risk group non-muscle-invasive bladder cancer.

Abstract

OBJECTIVE:

Although the current European Association of Urology(EAU) guideline recommends that patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) should accept intravesical chemotherapy or Calmette-Guerin (BCG) for no more than one year after transurethral resection of bladder tumor(TURBT), there is no consensus on the optimal duration of chemotherapy. Hence, we explored the optimal duration of maintenance intravesical chemotherapy in patients with intermediate-risk NMIBC.

SUBJECTS AND METHODS:

This was a real-world single-center retrospective cohort study. In total 158 patients with pathologically confirmed intermediate-risk NMIBC were included, who were divided into 4 subgroups based on the number of instillations given. We used Cox regression analysis and survival analysis chart to explore the 3-yr recurrence outcomes of tumor.The optimal duration was determined by receive operating characteristic curve (ROC).

RESULTS:

The median follow-up was 5.2 years. Compared with instillation for 1-2 months, the Hazard Ratios(HR) values of instillation for less than 1 month, maintenance instillation for 3-6 months and > 6 months were 3.57、1.57 and 0.22(95% CI 1.27-12.41;0.26-9.28;0.07-0.80, P = 0.03;0.62;0.02, respectively). We found a significant improvement in 3-yr relapse-free survival in intermediate-risk NMIBC patients who maintained intravesical instillation chemotherapy for longer than 6 months, and the best benefit was achieved with 10.5 months of maintenance chemotherapy by ROC.

CONCLUSIONS:

In our scheme, the optimal duration of intravesical instillation with pirrubicin is 10.5 months. This new understanding provides valuable experience for the precise medical treatment model of intermediate-risk NMIBC.

• Authors: Jian-Xin Chen, Wen-Ting Huang, Qing-Yun Zhang, Cheng-En Deng, Jue-Ling Wei, Yuan-Liang Xie, Rui Lin, Guan-Zheng Feng, Guang-Lin Yang, Jun Long, Hao-Yuan Lu, Zeng-Nan Mo
• Journal: BMC cancer (BMC Cancer) Vol. 23 Issue 1 Pg. 1018 (Oct 23 2023) ISSN: 1471-2407 [Electronic] England
• PMID: 37872516 (Publication Type: Journal Article)
• Copyright: © 2023. BioMed Central Ltd., part of Springer Nature.

Chemical References

• BCG Vaccine

Topics

• Humans
• Administration, Intravesical
• Maintenance Chemotherapy
• Retrospective Studies
• Non-Muscle Invasive Bladder Neoplasms
• Neoplasm Recurrence, Local (drug therapy, pathology)
• Urinary Bladder Neoplasms (pathology)
• BCG Vaccine (therapeutic use)
• Neoplasm Invasiveness