A new study suggests intravesical chemotherapy (IVC) administered between the first and second transurethral resection of bladder tumor (TURBT) significantly enhances recurrence-free survival (RFS) for high-risk non-muscle invasive bladder cancer (NMIBC) patients undergoing Bacillus Calmette-Guérin (BCG) therapy. Conducted at the Affiliated Hospital of Xuzhou Medical University, this research investigated the prognostic effects of IVC treatment on patients who underwent TURBT and subsequent BCG treatment from 2012 to 2023.
Bladder cancer, which ranks as the tenth most common malignancy worldwide, is categorized as either muscle-invasive or non-muscle-invasive based on its TNM (Tumor, Node, Metastasis) staging. NMIBC, encompassing stages like pTa, pT1, and carcinoma in situ, constitutes approximately 75% of bladder cancer cases. The study aimed to determine whether chemotherapy instilled directly within the bladder after surgical procedures might mitigate the risks of recurrence for patients already classified at high risk.
The research included 292 patients, divided based on whether they received IVC treatment between the two surgeries. The findings revealed IVC administration correlated with longer RFS across 85.6% of high-risk patients compared to 77.6% without such intervention.
"IVC treatment between the primary and second TURBT has been demonstrated to significantly improve RFS for high-risk NMIBC patients," the authors stated. They emphasized the need for additional treatments to maintain vigilant follow-ups for this patient cohort, as high-risk individuals typically demonstrate heightened recurrence rates. For patients stratified as intermediate-risk, IVC treatment did not yield significant benefits, highlighting the importance of tailoring therapeutic approaches based on individual patient risk profiles.
The cohort consisted of patients treated with BCG, known for its efficacy against NMIBC. Following surgery, patients were monitored closely, combining urine cytology and radiological assessments during follow-up consultations. The data gathered demonstrated statistically significant differences within the two patient groups over time, especially when observing those who received IVC therapy. This statistical advantage emphasizes the pivotal role of persistent postoperative management strategies.
Univariate and multivariate Cox regression analyses underscored IVC between TURBTs as independent risk factors for improved RFS, even after adjusting for other variables such as tumor stage and grade. "For high-risk patients, the treated group exhibited a significantly improved prognosis compared to the non-treated group," the researchers emphasized.
The study contributes significant insights to the prevailing discourse on bladder cancer treatment, accentuating the need for sustained investigative focus on postoperative strategies to optimize patient outcomes. While the research offers promising directions, it also faces limitations due to its retrospective nature and the relatively small sample size, indicating the necessity for future multicenter studies with larger cohorts to validate these findings and establish standardized treatment protocols for IVC usage.
Overall, the retrospective analysis provides compelling evidence supporting the efficacy of IVC between TURBTs, particularly for high-risk NMIBC patients undergoing BCG treatment, potentially guiding future treatment frameworks. This proactive approach may lessen the burden of NMIBC, granting patients prolonged survival without recurrence and enhancing their quality of life.
Further studies will be necessary to clarify optimal treatment schedules and to solidify the implementation of IVC as standard care for patients undergoing TURBT with high-risk NMIBC.