Low dose bacillus Calmette-Guerin for carcinoma in situ of the bladder: Long-term results
Low dose bacillus Calmette-Guerin for carcinoma in situ of the bladder: Long-term results
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DOI：
10.1016/s0022-5347(05)67974-8
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发表时间：
2000-01-01
影响因子：
6.6
通讯作者：
Lembo, A
中科院分区：
文献类型：
--
作者：
Losa, A;Hurle, R;Lembo, A
目的：卡介苗（BCG）是膀胱原位癌的标准治疗。然而，它的长期有效性仍然是debate.Materials和Methods：从1987年1月至1995年1月，70例连续原发性或继发性原位癌患者，或没有伴随孤立或多灶性乳头状肿瘤，每周滴注75毫克。巴斯德菌BCG;组织学诊断后6周。对复发的患者给予额外的诱导课程。无肿瘤患者接受每月滴注的维持疗程，持续12个月。结果：在诱导疗程1结束时，70名患者中有56名（80%）无肿瘤。在接受诱导疗程2的14例患者中，9例完全缓解（64.2%）。65例（92.8%）患者1 ~ 2个疗程后无病，继续维持治疗。无病患者的中位随访时间为74个月（范围17 - 134）。随后50例患者（71.4%）无疾病，12例（17.1%）复发，8例（11.4%）进展。至治疗失败的平均时间为18个月（范围6至69），至进展的平均时间为13个月（范围7至53）。死亡1例，其他原因死亡10例。粗生存率为84.2%，疾病特异性死亡率为1.4%，非疾病特异性死亡率为14.2%。与T1期乳头状肿瘤（p = 0.0001）或重度异型增生（p = 0.0005）相关的原位癌治疗失败的风险显著更大，与T1期乳头状肿瘤相关的原位癌疾病进展的风险显著更大（p = 0.0001）。结论：BCG膀胱灌注是膀胱原位癌的最佳保守治疗方法。低剂量BCG同样有效，副作用发生率较低，长期持续的积极结果。
Purpose: Bacillus Calmette-Guerin (BCG) is standard treatment for carcinoma in situ of the bladder. However, its long-term effectiveness is still debated.Materials and Methods: From January 1987 to January 1995, 70 consecutive patients with primary or secondary carcinoma in situ with or without concomitant solitary or multifocal papillary tumor were treated with weekly instillations of 75 mg. Pasteur strain BCG; for 6 weeks after histological diagnosis. An additional induction course was given to patients with relapse. Tumor-free patients were given a maintenance course of monthly instillations for 12 months.Results: At the end of induction course 1, 56 of the 70 patients (80%) were tumor-free. Of 14 patients given induction course 2, 9 had a complete response (64.2%). A total of 65 patients (92.8%) were disease-free after 1 or 2 courses and given the maintenance course. Median followup for disease-free patients was 74 months (range 17 to 134). Subsequently 50 patients (71.4%) were disease-free, 12 (17.1%) had recurrence and 8 (11.4%) had progression. Mean time was 18 months (range 6 to 69) to treatment failure and 13 months (range 7 to 53) to progression. Of the patients 1 died of disease and 10 of other causes. Crude survival was 84.2%, disease specific mortality 1.4% and nondisease specific mortality 14.2%. The risk of treatment failure was significantly greater for carcinoma in situ associated with stage T1 papillary tumor (p = 0.0001) or severe dysplasia (p = 0.0005), and the risk of disease progression was significantly greater for carcinoma in situ associated with stage T1 papillary tumor (p = 0.0001). The drug was well tolerated with few side effects.Conclusions: Intravesical BCG is the best available conservative therapy for patients with carcinoma in situ of the bladder. Low dose BCG is similarly effective, with a lower incidence of side effects and long lasting positive outcome.