BCG in perspective: advances in the treatment of superficial bladder cancer.
BCG in perspective: advances in the treatment of superficial bladder cancer.
复制标题
BCG 视角：浅表性膀胱癌治疗的进展。
作者：
D. Lamm
近年来，浅表性膀胱癌的治疗有了显著的进展。对照临床试验表明，细胞毒性化疗的益处主要适用于分化良好的肿瘤，是短期的，不包括疾病进展的减少。相比之下，膀胱内卡介苗免疫疗法对高级别肿瘤有效，提供长期保护，防止肿瘤复发，并减少疾病进展。对照临床试验一致表明，与硫替帕或阿霉素相比，卡介苗对肿瘤复发提供了更好的保护。与丝裂霉素C相比，六项研究中只有两项发现卡介苗治疗有显著优势；两项评估高危患者的研究均显示，与丝裂霉素c相比，BCG显著降低了肿瘤复发率。对照试验表明，更新的化疗方案和更强化的方案并不优于标准的硫替帕治疗。然而，免疫治疗的对照比较表明卡介苗优于干扰素和锁眼帽贝血青素。比较研究表明卡介苗优于化疗和其他免疫疗法，我们现在知道这是次优的卡介苗方案。在3个月时每周使用3次卡介苗（Connaught）治疗，原位癌的完全缓解从73%增加到87%。在无疾病的患者中，每隔6个月进行3周卡介苗治疗，可使Ta期和T1期膀胱癌的长期无疾病状态从50%提高到83%。这种维持治疗将单次6周卡介苗治疗获得的86%的生存率提高到92% （p < 0.04）。
The management of superficial bladder cancer has advanced significantly in recent years. Controlled clinical trials suggest the benefits of cytotoxic chemotherapy apply primarily to well-differentiated tumours, are short-term and do not include a reduction in disease progression. In contrast, intravesical bacillus Calmette-Guérin (BCG) immunotherapy is effective in high-grade tumours, provides long-term protection from tumour recurrence and reduces disease progression. Controlled clinical trials have consistently demonstrated that BCG provides superior protection from tumour recurrence compared with thiotepa or doxorubicin. In comparisons with mitomycin C, only two of six studies found a significant advantage for BCG therapy; both studies evaluating high-risk patients showed a significant reduction in tumour recurrence with BCG compared with mitomycin C. Controlled trials have demonstrated that newer chemotherapies and more intensive regimens are not superior to standard thiotepa treatment. However, controlled comparisons of immunotherapy suggest that BCG is superior to both interferon and keyhole-limpet haemocyanin. Comparative studies showing BCG to be superior to chemotherapy and other immunotherapies have employed what we now know to be suboptimal BCG regimens. Using three additional weekly BCG (Connaught) treatments at 3 months, complete response in carcinoma in situ is increased from 73 to 87%. In patients who are disease free, maintenance BCG using three weekly treatments at 6-month intervals improves long-term disease-free status in stage Ta and T1 bladder cancer from 50 to 83%. Such maintenance therapy improves the excellent 86% survival obtained with a single 6-week course of BCG to 92% (p < 0.04).