Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy
Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy
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DOI：
10.1016/j.urolonc.2020.05.002
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发表时间：
2020-09-01
影响因子：
2.7
通讯作者：
Margulis, Vitaly
中科院分区：
文献类型：
--
作者：
Freifeld, Yuval;Ghandour, Rashed;Margulis, Vitaly
目的：根治性肾输尿管切除术(RNU)后单次预防性膀胱内化疗(PIVC)可有效降低膀胱癌复发。尽管有高水平的证据，但pIVC没有得到充分利用。术中pIVC(I-pIVC)可能比术后pIVC(P-pIVC)更容易实施，也更安全。材料与方法：回顾分析接受RNU+I-pIVC或术后使用20~40 mg丝裂霉素C或1~2g吉西他滨的pIVC(P-PVC)的患者。复发率采用Kaplan-Meier曲线和对数等级检验。采用COX回归进行单因素和多因素分析。结果：137例患者进入最终分析。81%(111/137)为I-pIVC，19%(26/137)为PpIVC。在I-pIVC组中，HG、肌肉侵袭性疾病和吉西他滨的使用率较高。总体而言，74%(101/137)和26%(36/137)的患者分别使用丝裂霉素C和吉西他滨。术后12个月内有14%(19/137)的患者出现膀胱复发。中位膀胱复发时间为7个月(3-27个月)。术后12个月无复发生存率I-pIVC组为82%，P-pIVC组为72%(对数等级P=0.365)。结论：I-pIVC组可降低膀胱复发率。膀胱复发率与报告的术后灌注率相当。术中滴注可能更容易实施，并可能增加使用率。(C)2020 Elsevier Inc.保留所有权利。
Purpose: Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU.Materials and methods: Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis.Results: One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had PpIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3-27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365).Conclusions: I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates. (C) 2020 Elsevier Inc. All rights reserved.