[Post-Operative Immediate Single Instillation of Chemotherapy as Prevention of Recurrence after Transurethral...

Area of Science:

• Urology
• Oncology
• Cancer Chemoprevention

Background:

• Non-muscle-invasive bladder cancer (NMIBC) requires effective chemoprevention strategies to reduce recurrence.
• Bacillus Calmette-Guerin (BCG) and intravesical chemotherapy are standard treatments, but their efficacy and optimal timing vary.
• Immediate single instillation (SI) of chemotherapy post-transurethral resection of bladder tumor (TURBT) is an area of investigation.

Purpose of the Study:

• To evaluate the efficacy of immediate single instillation (SI) of pirarubicine hydrochloride (THP) for NMIBC chemoprevention.
• To compare recurrence rates between patients receiving SI of THP and those receiving standard BCG induction or delayed chemotherapy.
• To identify recurrence risk factors in NMIBC management.

Main Methods:

• Retrospective analysis of 256 intermediate and high-risk NMIBC patients treated between 1999 and 2014.
• Comparison of outcomes between an SI of THP group (introduced in 2010) and a control group (BCG induction or delayed chemotherapy).
• Follow-up included cystoscopy and urine cytology, with statistical analysis using univariate and multivariate models.

Main Results:

• The 3- and 5-year non-recurrence rates were 80.3% for the SI group versus 69.7% and 64.5% for the control group, respectively.
• Univariate analysis showed a significant difference in recurrence rates between the groups (P=0.025).
• Multivariate analysis identified the choice of chemotherapy over BCG and the absence of SI as significant recurrence risk factors.

Conclusions:

• Immediate single instillation of pirarubicine hydrochloride is an effective chemoprevention strategy for reducing recurrence in NMIBC.
• This approach demonstrates superior outcomes compared to historical controls receiving standard intravesical therapies.
• Further research, including randomized trials, is warranted to confirm these findings, acknowledging the retrospective nature of this study.