Clinical efficacy of transurethral resection of bladder tumor combined with gemcitabine intravesical instillation in the treatment of superficial bladder cancer / 中国基层医药

Objective@#To investigate the effect of transurethral resection of bladder tumor (TURBt) combined with gemcitabine intravesical instillation in the treatment of superficial bladder cancer.@*Methods@#From May 2011 to January 2016, 112 patients with superficial bladder cancer were treated in the Seventh Hospital of Ningbo.According to the digital table, the patients were randomly divided into two groups: A group was treated by TURBt, and B group was treated by TURBt combined with gemcitabine.The postoperative complications, postoperative recurrence and quality of life were compared between the two groups.@*Results@#The operation time, indwelling catheter time and hospitalization time between the two groups had no statistically significant differences (all P>0.05). The postoperative complications of the two groups were frequent urination, dysuria and hematuria.The incidence rate of complications of A group was 39.29%, which was significantly higher than that of B group (χ2=36.597, P<0.05). The recurrence rate of B group was significantly better than that of A group (χ2=8.617, P<0.05). After treatment, the quality of life of the two groups was significantly improved compared with that before treatment, and compared with that of A group, the psychology, physiology, independence, social environment, quality of life scores of B group increased more significantly (t=29.217, 25.446, 19.517, 24.339, 36.001, all P<0.05).@*Conclusion@#Transurethral resection of bladder tumor combined with gemcitabine intravesical instillation in the treatment of superficial bladder cancer can ensure the treatment effect, at the same time, it can effectively reduce the postoperative complications and the emergence of various risk, reduce postoperative recurrence and improve the quality of life of patients, it has great significance and is worthy of promotion.

Effects of Doxorubicin Perfusion Therapy on Therapeutic Efficacy and Related Indexes in Patients with Superficial Bladder Cancer underwent TURBT / 中国药房

OBJECTIVE:To investigate the effects of doxorubicin perfusion therapy on therapeutic efficacy and related indexes in patients with superficial bladder cancer underwent transurethral resection of bladder tumor (TURBT).METHODS:Medical records of 96 patients with superficial bladder cancer were analyzed retrospectively and divided into observation group and control group according to drug use,with 48 cases in each group.Observation group was given perfusion therapy of 0.9％ Sodium choride solution 40 mL containing 20 mg doxorubicin 7 d after surgery.Control group was given TURBT combined with equal amount of 0.9％ Sodium chloride solution.Both groups received treatment for consecutive 10 months,once a week in first 8 weeks,later once a month.The recurrence rate and disease progression of 2 groups were observed and compared,and the levels of sICAM-1 and sVCAM-1,the levels of tumor marker DKK1 and VEGF were observed before and after treatment.The occurrence of ADR was recorded.RESULTS:After 24 months of treatment,remission rate and control rate of observation group were significantly higher than control group,with statistical significance (P＜0.05).There was no statistical significance in the progressive survival rate between 2 groups (P＞0.05).Before treatment,there was no statistical significance in the levels of sICAM-1、sVCAM-1、DKK1 and VEGF between 2 groups (P＞0.05);after treatment,the levels of sICAM-1、sVCAM-1 、DKK1 and VEGF in 2 groups were significantly lower than before treatment,the observation group was significantly lower than the control group,with statistical significance (P＜ 0.05).The recurrence rate,the incidence of frequent/urgent urination,hematuria and dysuria in observation group after treatment were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:For patients with superficial bladder cancer underwent TURBT,doxorubicin perfusion therapy can significantly reduce recurrence rate,relieve tumor deterioration and reduce tumor activity with good safety.

Fulguración con láser de la recidiva de tumores vesicales superficiales bajo anestesia local: diseño de procesos / Laser fulguration of superficial bladder tumor recurrence under local anesthesia. design process

Introduction: The process design is one of the most interesting tools to ensure the quality of health care before the start of an activity. Although the gold standard treatment of superficial bladder tumors remains transurethral resection (TUR), the onset of laser energy source with better endourological systems allows us to adopt alternative therapies. The aim of this pilot study is to describe the design and protocol in 37 patients with a novel process consisting of outpatient treatment under local anesthesia of bladder tumors with holmium laser. Material and Methods: Pilot study includes 37 patients between January 2012 and December 2013, for the development of a process of holmium laser bladder fulguration without anesthetic infiltration in outpatient study. It analyzes and studies the procedure tolerance, development of immediate complications, visual analog scale (VAS) of pain, patient satisfaction, hospital stays avoided, problems during the application process and development. Results: The mean age of the patients was 69.2 +/- 10.3 years, 100 percent of patients prefer this procedure instead conventional transurethral resection and VAS rating presenting ≤ 3. There were no important complications. Only one patient was admitted at hospital due to hematuria resolved without surgical treatment. Conclusions: The development and implementation of fulguration of superficial papillary bladder tumors with holmium laser process is simple, well tolerated, ambulatory and without complications, with no need of hospital stay.

Introducción: El diseño de procesos es una de las herramientas de mayor interés para asegurar la calidad de la asistencia sanitaria antes del comienzo de una determinada actividad. Aunque el gold standard del tratamiento de los tumores vesicales superficiales sigue siendo la resección transuretral (RTU), la aparición de la fuente de energía láser con mejores medios endourológicos nos permite adoptar otras alternativas terapéuticas. El objetivo de este estudio piloto es describir el diseño y protocolo en 37 pacientes de un proceso novedoso consistente en el tratamiento en régimen ambulatorio y bajo anestesia local intravesical de los tumores de vejiga con láser de holmium. Material y Métodos: Estudio piloto que incluye 37 pacientes entre enero de 2012 y diciembre de 2013, para la elaboración de un proceso de fulguración vesical con láser de holmium sin infiltración anestésica en régimen ambulatorio. Se analiza y estudia tolerancia al procedimiento, desarrollo de complicaciones inmediatas, escala visual analógica (EVA) del dolor, satisfacción del paciente, estancias hospitalarias evitadas, problemas durante la aplicación del proceso y desarrollo del mismo. Resultados: La edad media de los pacientes fue 69,2 +/- 10,3 años, presentando puntuación EVA ≤ 3. No existieron complicaciones importantes. Hubo un ingreso por hematuria tardía que se resolvió de forma conservadora. Conclusiones: La elaboración y aplicación del proceso de fulguración de tumores vesicales papilares superficiales con láser holmium es una técnica sencilla, con buena tolerancia, ambulatoria y sin complicaciones de interés, con eliminación de estancias hospitalarias.

The efficacy and safety analysis of immediately intravesical instillation of same dose variable concentration of pirarubicin for superficial bladder cancer / 重庆医学

Objective To compare the efficacy and safety of intravesical instillation of pirarubicin (T HP) to prevent the post -operative recurrence of superficial bladder cancer with same dose variable concentration .Methods A tota1 of 56 cases of superficial bladder cancer after transurethral resection (TURBT ) were randomly divided into two groups(High concentration group :25 cases , Low concentration group :31 cases) .Infusion dose of THP is 30 mg .The concentration of THP is 1 .0 g/L in H group ,0 .6 g/L in L group .Both groups were installed within 24 hours after operation .Both groups were installed once a week for 8 weeks after the first installation ,then once a month until 1 year after operation .All cases were followed up ,the tumor recurrence time ,recurrence rates and complications were compared .Results All cases except 2 in L group received 6 -30 months follow up ,with an average time of 17 .6 months .In H group ,1 patients recurred during the follow-up period ,with a recurrence rate of 4 .0% and recurrence time of 12 .4 months ,while in L group ,3 cases recurred ,with a recurrence rate of 10 .3% and an average recurrence time of 9 .8 months .Adverse reactions were main1y Urinary irritation symptoms .The difference of recurrence rate and average recurrence time in each group were statistically significant (P0 .05) .Conclusion This study shows that high concentration THP intravesical instillation could effectively reduce the recur-rence rate and delay the recurrence time .Each concentration was well tolerated .

Two Cases of Pulmonary Complications Following Intravesical Bacillus Calmette-Guerin Immunotherapy in Patients with Superficial Bladder Cancer / 결핵

Intravesical instillation of the bacillus Calmentte-Gu rin(BCG), an attenuated strain of Mycobacterium bovis, is an approved method for the treatment of superficial bladder cancer. Because BCG is a living organism, the potential for infection exists. BCG is generally well tolerated, with complications in less than 5% of those treated with use of current practices. The most frequent symptoms of toxicity associated with intravesical BCG immunotherapy include bladder irritation, frequency, and dysuria. Systemic reactions are less common but more serious than local side effects, and include fever, chills, malaise, rash, hepatitis, pneumonitis, arthritis and sepsis. In rare cases, BCG treatment can result in a systemic infection that requires antituberculous therapy. The pulmonary toxicity that results from intravesical BCG treatment is generally characterized by one of two types : systemic allergic reaction with pulmonary reticulonodular opacities depicted on chest radiographs with cellular findings consisting of activated lymphocytes, and actual BCG mycobacteremia with a miliary pattern depicted on chest radiographs and granuloma formation which rarely results in positive acid-fast stain or culture results. Recently we experienced two types of pulmonary complications following intravesical BCG immunotherapy in patients with superficial bladder cancer. We report two cases with a review of literatures.

Application of Scoring System Reflecting Various Prognostic Factors to the Prediction of Recurrence in Superficial Bladder Carcinoma / 대한비뇨기과학회지

PURPOSE: Although the conventional clinical, histopathological, and moleculobiological factors of bladder tumor provide a certain degree of stratification of tumor biological potential, it is difficult to make an accurate and reliable prediction of tumor recurrence with known prognostic factors due to tumor heterogeneity. So we attempted to devise a scoring system reflecting various prognostic factors to predict tumor recurrence more accurately in superficial bladder carcinoma. MATERIALS AND METHODS: We reviewed retrospectively the clinical records and pathological specimens of 46 patients with superficial bladder cancer, who underwent transurethral resection of bladder tumor and intravesical Bacillus Calmette-Guerin (BCG) instillation between September, 1991 and December, 1996. The mean follow-up was 29 months. We examined the prognostic parameters such as tumor stage, grade, tumor with or without CIS, size, number, p53 expression and investigated the relation between the prognostic factors and the tumor recurrence. We assigned 1 and 2 for Ta and T1; 1 and 2 for tumor size( or =3cm); 1 and 2 for tumor number( or =3); 1, 2 and 3 for grades( I, II and III); 2 if CIS is found and 1 if not; 2 if p53 is expressed more than 20%(strong positive) and 1 if p53 is not expressed or less than 20%(weakly positive). We summed the points assigned to all categories for each patient, and investigated tumor recurrence according to total points by the scoring system. We corrected the scoring system by deleting the insignificant prognostic factors in this study which was named the corrected scoring system. We recounted the points based on it. RESULTS: Tumor recurred in 15 out of 46 patients(32.6%). Recurrence rate in patients with p53(strong positive) and with p53(weakly positive) was 47.3 and 18.5%, respectively (p0.05) and that of grades I, II and III was 0, 20.8 and 55.6%(p or =3cm and0.05). Patients with number of tumors or =3(53.3%)(p or =3) were considered as prognostic factors that affected the recurrence. For patients with summed points 4 to 9 based on the corrected scoring system, the recurrence rate was zero%(0/16) in patients with lower score(4 or 5), 31.8%(8/21) in those with intermediate score(6 or 7), and 77.8%(7/9) in those with higher score(8 or 9)(lower and intermediate score vs higher score: p<0.005). CONCLUSIONS: The results suggested that this scoring system reflecting various prognostic factors can be a reliable method predicting the tumor recurrence. This scoring system awaits its application to more cases of bladder tumor and its refinement, if necessary.

Predictive Value of Microstaging in the Recurrence and the Progression of T1 Superficial Bladder Cancer / 대한비뇨기과학회지

PURPOSE: There are many prognostic factors in the recurrence and the progression of T1 superficial bladder cancer. Among these factors, microstaging evaluation in T1 bladder cancer may be of important value in patients with T1 superficial bladder cancer. To evaluate the usefulness of microstaging evaluation, we analyzed the microstage in T1 superficial bladder cancer and analyzed the recurrence rate and the progression rate of each microstage. MATERIALS AND METHODS: A retrospective analysis was done on 87 patients with T1 primary superficial bladder cancer managed in our hospital between January 1992 and April 1998. Microstages were assigned according to the following system: pT1a, invasion of lamina propria: pT1b, invasion to the level of the muscularis mucosa; pT1c, invasion through the muscularis mucosa but superficial to the muscularis propria. We analyzed the relationship between the microstage and the grade, the relationship between the recurrence or the progression of diseases and the grade of the tumor, the relationship between the grade or the microstage and the recurrence of diseases. All specimens were obtained from transurethral resection. RESULTS: The recurrence rates of pT1a, pT1b and pT1c were 9.1%(3/33), 40%(8/33) and 64.7%(22/33) respectively(p<0.001). The progression rates of pT1a, pT1b and pT1c were 0%(0/33), 10%(2/20) and 20.6%(7/34) respectively(p=0.005). The recurrence rates of grade I, grade II and grade III were 23.1%(3/13), 26.7%(12/45) and 62.1%(18/29) respectively(p=0.002). The progression rates of grade I, grade II and grade III were 7.7%(1/13), 4.4%(2/45) and 20.7%(6/29) respectively(p=0.062). pT1a, pT1b and pT1c were 21.2%(7/33), 20%(4/40) and 5.9%(2/34) in the patients of the grade I. pT1a, pT1b and pT1c were 69.7%(23/33), 50%(10/20) and 35.3%(12/34) in the grade II. pT1a, pT1b and pT1c were 9.1%(3/33), 30%(6/20) and 58.8%(20/34) in the grade III. Thus the relationship between the grade and the microstage was statistically significant(p=0.001). The recurrece rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 14.3%(1/7), 0%(0/4) and 100%(2/2). The recurrence rates of pT1a in the grade II , pT1b in the grade II and pT1c in the grade II were 8.7%(2/23), 40%(4/10) and 50%(6/12). The recurrence rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 66.7%(4/6) and 77.8%(14/20)(p=0.176). The progression rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 0%(0/7), 0%(0/4) and 50%(1/2). The progression rates of pT1a in the grade II, pT1b in the grade II and pT1c in the grade II were 0%(0/23), 10%(1/10) and 8.3%(1/12). The progression rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 16.7%(1/6) and 25%(5/20)(p=0.526). CONCLUSIONS: Microstaging in T1 superficial bladder cancer appears to be a significant prognostic factor in the recurrence and the progression of the diseases.

The Clinical Prognostic Factors of Patients with Superficial Bladder Cancer to a Second Course of Intravesical Bacillus Calmette-Guerin / 대한비뇨기과학회지

PURPOSE: When combined with transurethral resection, intravesical Bacillus Calmette-Guerin(BCG) is effective in delaying recurrence and progression of superficial bladder cancer including carcinoma in situ. Dose schedules vary and the optimum regimen has not been defined. And criteria for selection of patients who may benefit from an additional course of BCG have not yet been established. In an attempt to identify patients who are likely to respond, we analyzed our experience in patients with superficial bladder cancer treated with a subsequent course of BCG therapy MATERIALS AND METHODS: From June 1989 until June 1996, 74 patients with superficial bladder tumor were treated under protocol at our institution with intravesical BCG. Of 74 patients who received an initial once a week for 6 week and once a month for 3-month of intravesical BCG(course 1) for superficial transitional cell carcinoma of the bladder, 21 were treated another course(course 2). RESULTS: First course of BCG was successful in 43(64.1%) of 67 patients treated for prophylaxis and 3(42.8%) of treated for carcinoma in situ. Of 28 patients who failed the initial treatment course, 21 were given an additional BCG therapy. Subsequent progression of disease(muscle infiltration, metastasis or local progression) occurred in 3 patients(14.2%). Of 18 patients(85.7%) without progression 11(52.3%) had a complete response and 7(33.3%) had new tumors, and they were rendered free of disease after transurethral resection. The median duration of response to course 1 of intravesical BCG was shorter for patients with disease progression or recurrence after course 2 than for those with no progression or recurrence(13.8 and 21.3 months, p<0.05). The median intenal between course 1 and 2 of intravesical BCG was 18 months. The internal from course 2 of intravesical BCG to progression or recurrence correlated with the duration of response to course 1 of treatment(p<0.05). CONCLUSIONS: Our analysis indicate that the usefulness of a subsequent course of intravesical BCG for the treatment of new tumors is related to the duration of response to course 1. Patients with a long-lasting response to the initial course of BCG(18 months or more) are likely to benefit from another course.

Significance of Invasion to the Muscularis Mucosae on the Progression of Superficial Bladder Cancer / 대한비뇨기과학회지

We tried to determine the significance of invasion to the muscularis mucosae on the progression and recurrence of the superficial bladder cancer. Muscularis mucosae was composed of the smooth muscle bundles around relatively large vessels and found in the lamina propria approximately midway between the surface mucosa and the true muscular layer, lying parallel to the mucosa. Between January 1984 and December 1993, 81 patients with diagnosed superficial bladder cancer showing lamina propria invasion (pTl) were treated by transurethral resection (TUR) at our hospital. The mean age was 59.4 years ( range, 31-86 years), the mean follow-up period was 35.3 months ( range, 13-120 months) and the male : female ratio was 69 : 12. We subclassified superficial bladder cancer showing lamina propria invasion into two groups with ( pT1b) or without ( pT1a) cancer invasion to the muscularis mucosae. The muscularis mucosae was identified in 58 (71.6%) of 81 cases. In the other cases ( 28.4% ), relatively large vessels were used as the landmark instead of the muscularis mucosae. Of 81 bladder cancers, 52 (64.2%) were diagnosed as pT1a and 29 (35.8%) as pTlb. The progression rate of pT1b cancer (41.4% ) was significantly higher than that of pT1a cancer (3.8% ) (p= 0.001). And the recurrence rate of pT1b cancer (55.2% ) was significantly higher than that of pT1a cancer ( 26.9 %)(p= 0.024). In conclusion, superficial bladder cancer invading to the muscularis mucosae has a high risk for disease progression after TUR. Careful follow-up examination and aggressive therapy should be recommended in patients with these tumors.

Results and Indication of Patients with Superficial Bladder Cancer to a Second Course of Intravesical Bacillus Calmette-Guerin / 대한비뇨기과학회지

Although initial and additional course of intravesical bacillus Calmette-Guerin (BCG) immunotherapy have proved effective in the treatment and prophylaxis of superficial bladder cancers, including carcinoma in situ, a significant minority of patients will fail such therapy and criteria for selection of patients who may benefit from an additional course of BCG have not yet been established. In an attempt to identify patients who are likely to respond, we analyzed our experience in patients with superficial bladder cancer treated with a subsequent course of BCG. Of 86 patients who received an initial once a week for 6-week and once a month for 3-month of intravesical BCG for superficial transitional cell carcinoma of the bladder 18(21 per cent) were treated with another course. First course of BCG was successful in 50 (66 per cent) of 76 patients treated for prophylaxis and 4 (40 per cent) of 10 treated for carcinoma in situ. The response rate for the total patients population treated with first course was 62.8 per cent (54 of 86). Of 32 patients who failed the initial treatment course 18 were given an additional BCG therapy, subsequent progression of disease occurred in 2 patients( 11 per cent). Of the l6 patients (89 per cent) without progression 10 (56 percent) had a complete response and 6 (33 per cent) had new tumors. and they were rendered free of disease after transurethral resection. The median interval between course 1 and 2 of intravesical BCG was 12 months (range, 4-40 months) and the median followup after course 2 was 22 months (range, 4-69 months). The median duration of response to course 1 of BCG was shorter for patients with disease progression or recurrence after course 2 than for those with no progression or recurrence (8 and 15 months) . The results suggest that initial and subsequent course of intravesical BCG are effective in the treatment and prophylaxis of superficial bladder cancer, including carcinoma in situ, and a subsequent treatment with BCG is most likely to be useful in patients who have a sustained response to the initial treatment.

The Prognostic Parameters for Recurrence in the Superficial Bladder Cancer / 대한비뇨기과학회지

A retrospective study of 46 patients with primary superficial bladder tumor was performed to identify the prognostic parameters which affect tumor recurrence. We examined 4 parameters such as stage, grade, size and number of tumor and each parameter was compared with recurrence rate respectively. The recurrence rate of stage Ta and T1 within 2 years was 33.3 % and 71% (p0.05) and tumor size had no effect on tumor recurrence(p>0.06). Early recurrence rate within 1 year of grade I, II and III was 20%, 32% and 100% respectively(p< 0.01 ) but stage, number of tumor and tumor size were not correlated significantly with early recurrence rate within 1 year. A separate evaluation of the 4 parameters showed that stage and grade have a significant influence on tumor recurrence. Therefore more aggressive therapy and intensive follow-up should be considered for patients with high stage and high grade tumors.

Grading of Superficial Bladder Cancer by Mitotic Indices / 대한비뇨기과학회지

The relationship between the prognostic factors and recurrence was investigated in the followup study of patients with 51 superficial (stage Ta to T1) transitional cell bladder carcinomas for more than 3 years. WHO grade, modified Bergkvist grade and number of tumor were related to mitotic indices( p <0.05), but size of tumor was related to MAI only(p<0.05) In univariate analysis of prognostic factors, mitotic indices, number of tumor and posterior wall involvement were related to 3-year recurrence(p < 0.05). In multivariate analysis of prognostic factors, which were significantly related in univariate analysis, VCM and posterior wall involvement were related to 3-year recurrence and their hazard ratios were 9.33 times and 6.16 times In recurrence-free survival curve of prognostic factors, mitotic indices, number of tumor and posterior wall involvement were related (p <0.05). In classifying WHO grade 2 according to modified Bergkvist grade and mitotic indices, they were related to recurrence (p <0.05). The results show that superficial transitional cell bladder carcinomas can be efficiently categorized into prognostic groups by mitotic indices and the results provide a new classification system for superficial transitional cell bladder carcinomas.

Production of tumor necrosis factor by intravesical administration of bacillus Calmette Guerin in patients with superficial bladder cancer

Although an immune response to bacillus Calmette Guerin (BCG) has often been associated with antitumor activity, the action mechanism(s) of intravesical BCG therapy for prophylaxis and treatment of superficial bladder cancer is not clearly understood. In an attempt to evaluate the roles of tumor necrosis factor (TNF)-alpha and lymphotoxin (LT) in the antitumor activity, TNF-alpha productivities by peripheral blood monocytes, serum levels of TNF-alpha, and LT productivities by peripheral blood lymphocytes were studied in superficial bladder cancer patients after six intravesical administrations of BCG. TNF-alpha productivities by peritoneal macrophages of guinea pigs were also studied after six intravesical administrations of BCG. The maximum TNF-alpha productivities by peripheral blood monocytes of superficial bladder cancer patients were seen after the fourth week of administration of BCG, and the serum TNF-alpha levels were also slightly increased after intravesical BCG administration in the superficial bladder cancer patients. LT productivities by peripheral blood lymphocytes of superficial bladder cancer patients were significantly enhanced and the maximum LT productivity was also seen after the third or fifth BCG administration. TNF-alpha productivities by peritoneal macrophages of guinea pigs were significantly enhanced and the maximum TNF-alpha productivity was seen after the second or third BCG administration. Our data might suggest that six consecutive intravesical BCG administrations could induce the increased productions of TNF-alpha and LT, which might play an important role in the antitumor activity in superficial bladder cancer.Although an immune response to bacillus Calmette Guerin (BCG) has often been associated with antitumor activity, the action mechanism(s) of intravesical BCG therapy for prophylaxis and treatment of superficial bladder cancer is not clearly understood. In an attempt to evaluate the roles of tumor necrosis factor (TNF)-alpha and lymphotoxin (LT) in the antitumor activity, TNF-alpha productivities by peripheral blood monocytes, serum levels of TNF-alpha, and LT productivities by peripheral blood lymphocytes were studied in superficial bladder cancer patients after six intravesical administrations of BCG. TNF-alpha productivities by peritoneal macrophages of guinea pigs were also studied after six intravesical administrations of BCG. The maximum TNF-alpha productivities by peripheral blood monocytes of superficial bladder cancer patients were seen after the fourth week of administration of BCG, and the serum TNF-alpha levels were also slightly increased after intravesical BCG administration in the superficial bladder cancer patients. LT productivities by peripheral blood lymphocytes of superficial bladder cancer patients were significantly enhanced and the maximum LT productivity was also seen after the third or fifth BCG administration. TNF-alpha productivities by peritoneal macrophages of guinea pigs were significantly enhanced and the maximum TNF-alpha productivity was seen after the second or third BCG administration. Our data might suggest that six consecutive intravesical BCG administrations could induce the increased productions of TNF-alpha and LT, which might play an important role in the antitumor activity in superficial bladder cancer.

Adjuvant therapy with mitomycin C intravesically for superficial bladder cancer.

A retrospective study was carried out using the OPD cards of 25 cases (stage A, grade 2) with transitional cell carcinoma (superficial bladder cancer), to determine effects of Mitomycin C on preventing tumor recurrence. Of these patients, 13 had been managed by surgery (TUR/TUF) only (group 1). The remaining 12 cases (group 2) were given Mitomycin C (intravesically) administration at two weeks post surgery (4 cases/group 2 A) and after several tumor recurrence was found in eight cases (group 2 B). The study compared the mean recurrence rate per year of these three groups. The mean recurrence rate per year of group 1, group 2 A and group 2 B was 0.34, 0.68 and 1.22, respectively, and there was no statistical difference between them. The percentage of recurrence in group 1, group 2 A and group 2 B was 61.5, 50 and 75, respectively. In conclusion, Mitomycin C dose not significantly reduce the recurrence of tumors, but if used two weeks after surgery it dose reduce the percentage of recurrence.

DNA flow cytometry in superficial bladder cancer / 대한비뇨기과학회지

A total or 44 patients with superficial bladder cancer underwent flow cytometric analysis of nuclei obtained from paraffin embedded specimens(44 first and 8 recurrent). Tumors could be classified according to their DNA content as diploid or aneuploid and to the proportion of proliferating cells (S-phase fraction). The degrees of cellular differentiation were related to the DNA patterns and to S-phase fractions. And reccurence-free rates were compared according to the DNA patterns. Of the total 52 specimens, 22 (42% ) showed aneuploid DNA patterns. The majority (83.9%) of low grade tumors had diploid pattern and the majority (81%) of high grade tumors had aneuploid pattern (p<0.005). Mean S-phase fraction of tota1 52 paraffin blocks was estimated as 11.17% (S.D.: 5.75). Mean S-phase fraction by grade was estimated as 9.95% (S.D. : 5.l4) in low grade tumors and 13.89%(S.D. : 6.10) in high grade tumors (p<0.05). Five-year recurrence-free rate was 77.8% in diploid group and 29.4% in aneuploid group (p<0.005). Mean S-phase fraction of the non-recurrent tumors was 8.91% (S.D. : 3.49). and that of the recurrent tumors 14.32% (S.D. : 7.76). The above results suggest that DNA ploidy and S-phase fraction as measured flow cytometry appear to be an important prognostic factors for superficial bladder cancer. And this information may be used to plan patient treatment according to the predicted risks.

Prophylactic effect of intravesical BCG therapy in superficial bladder cancer / 대한비뇨기과학회지

Intravesical Bacillus Calmette-Guerin (BCG) had been shown to be effective therapy and prophylaxis against recurrent tumor in patients with superficial bladder cancer, including carcinoma in situ. A study was performed to determine the prophylactic efficacy of intravesical Tice-Chicago strain BCG instillation in 47 patients with high risk superficial bladder cancers (stage Ta or T1). Group I consisted of 17 patients with a history of at least 1 tumor recurrence before BCG therapy. Most had received various forms of intravesical chemotherapy as prophylaxis following previous TUR of the bladder tumor. The tumor recurrence rate of patients was compared with the rate during the 2 years prior to BCG therapy as a personal historical control. The simple recurrence rate of group I was 41.2% before and 5.9% after intravesical BCG therapy. According to the person-years method. the number of recurrent tumors per patient-months was 0.0149 before and 0.0021 after BCG therapy(p>0.05). Group R consisted of 30 consecutive new patients. The tumor recurrence rate after BCG therapy was compared with that of historical controls in our hospital. There were lI6 other patients who had previously been treated by transurethral resection and most had also received intravesical chemotherapy. The simple recurrence rate was 20% in BCG patients and 44.8% in the historical controls. According to the person-years method, the number of recurrences per patient-months in this group was 0.0081 and 0.0576 in the historical group. The results show that intravesical BCG instillation is effective and safe as a prophylaxis against the recurrence of the superficial bladder tumors. The granulomatous response in the bladder and PPD responsiveness have their statistical correlation with status free of tumor.