Clinical Original Article
Efficacy and complications of intravesical instillation of BCG for prevention of recurrence of moderate and high-risk non muscle invasive bladder cancer
Weibing Sun, Zhiyu Liu, Quanlin Li, Xishuang Song, Xiangbo Kong, Chunxi Wang, Qifu Zhang, Qingguo Zhu, Changfu Li, Wanhai Xu, Guanghai Yu, Cheng Zhang, Jinyi Yang, Tianjia Song, Jiye Zhao, Qizhong Fu, Lixin Wang, Quanzhong Ding, Xuehui Cai, Chuize Kong
Published 2019-01-15
Cite as Chin J Urol, 2019, 40(1): 14-19. DOI: 10.3760/cma.j.issn.1000-6702.2019.01.003
Abstract
ObjectiveTo assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.
MethodsThe clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region, were analyzed retrospectively. The first part, data of 106 patients with moderate, high-risk NMIBC were collected. A total of 83 patients were male, while the other 23 patients were female. The average age was 66.7 years old.The clinical staging were T1 in 86(81.1%) cases, Ta in 20(18.9%) cases and carcinoma in situ in 6(5.7%)patients. Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor. The incidence rate of recurrence and progression during more than 6 months’ follow-up time were observed. Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method. The second part, treatment compliance of 276 patients with bladder cancer, including moderate/high-risk NMIBC in 263 cases, moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries, were observed. Patients consisted of 211 males and 65 females with average age of 68.3 years.
ResultsWith a median follow-up of 12 months, 9(8.5%) patients experienced tumor recurrence and 2(1.9%)patients were found progression in the first part. The one-year cancer free recurrence rate of the patients was 91.5%. Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR=3.214, 95%CI 0.804-12.845, P=0.099). In the second port, an incidence rate of adverse effects was 64.1% (177/276). The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment. A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 %), 9 cases (3.3 %) with economic reasons and 11 cases(4.0%)with serious complications.
ConclusionsNMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects. Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.
Key words:
Non-muscle invasive bladder cancer; Bacillus Calmette Guerin; Recurrence; Adverse effects
Contributor Information
Weibing Sun
Department of Urology, The Second Hospital of Dalian Medical University, Dalian 116023, China
Zhiyu Liu
Department of Urology, The Second Hospital of Dalian Medical University, Dalian 116023, China
Quanlin Li
Department of Urology, The First Hospital of Dalian Medical University, Dalian 116021, China
Xishuang Song
Department of Urology, The First Hospital of Dalian Medical University, Dalian 116021, China
Xiangbo Kong
Department of Urology, China-Japan Union Hospital of Jilin University, Changchun 130033, China
Chunxi Wang
Department of Urology, The First Hospital of Jilin University, Changchun 130021, China
Qifu Zhang
Department of Urology, Jilin Provincial Tumor Hospital, Changchun 130012, China
Qingguo Zhu
Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
Changfu Li
Department of Urology, The Third Affiliated Hospital of Harbin Medical University, Harbin 150040, China
Wanhai Xu
Department of Urology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
Guanghai Yu
Department of Urology, Dalian Municipal Central Hospital, Dalian 116033, China
Cheng Zhang
Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin 150011, China
Jinyi Yang
Department of Urology, Friendship Hospital of Dalian, Dalian 116001, China
Tianjia Song
Department of Urology, The First People's Hospital of Jinzhou District in Dalian City, Dalian 116100, China
Jiye Zhao
Department of Urology, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China
Qizhong Fu
Department of Urology, Dalian University Affiliated Zhongshan Hospital, Dalian 116001, China
Lixin Wang
Department of Urology, The 210th Hospital of PLA, Dalian 116021, China
Quanzhong Ding
Department of Urology, Lushunkou District of Dalian City People's Hospital, Dalian 116041, China
Xuehui Cai
Department of Urology, Wafangdian City Center Hospital, Wafangdian 116300, China
Chuize Kong
Department of Urology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
