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Theories behind Bacillus Calmette-Guerin failure in high-risk non-muscle-invasive bladder cancer and update on current management

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cancer Pathogenesis and Therapy 2024年第2期2卷 74-80页

作者： Hanna Maroof Louise Paramore Ahmed Ali Department of Urology Frimley Park HospitalPortsmouth RdFrimleyCamberley GU167UJUnited Kingdom

bladder cancer encapsulates a wide spectrum of disease severities,with non-muscle invasive bladder cancer(NMIBC)representing an entirely different entity from muscle-invasive *** Calmette-Guerin(BCG)is one of the most successful intravesical treatment methods for patients ***,a considerable pro-portion of patients fail to respond to BCG *** the propensity for recurrence in patients with high-risk bladder cancer,these patients present with surgical *** is currently no gold standard for salvage treatment post-BCG failure or unified definition as to what that *** this review,we discuss the mechanisms of action and pathophysiology of BCG,potential theories behind BCG failure,and the scope of novel treatments forthis surgical conundrum.

关键词： Cystectomy Hyperthermia Induced Immunotherapy Mycobacterium bovis non-muscle-invasive bladder cancer

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Cryoablation techniques in bladder cancer: A review

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Frigid Zone Medicine 2024年第2期4卷 72-77页

作者： Binglei Ma Wilhem Teixeira Lijuan Jiang State Key Laboratory of Oncology in South China Collaborative Innovation Center of Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060China Department of Urology Sun Yat-sen University Cancer CenterGuangzhou 510060China

bladder cancer(BC)ranks as the tenth most common cancer ***,BC is broadly categorized into urothelial and non-urothelial *** carcinoma represents over 90%of BC in most regions *** standard treatment procedure for diagnosing and treating non-muscle-invasive bladder cancer(NMIBC)is transurethral resection of bladder tumors(TURBT).Currently,the standard of care for muscle-invasive bladder cancer(MIBC)is neoadjuvant chemotherapy followed by radical *** therapy is a medical technique that uses extremely low temperatures to destroy diseased *** treatment serves as a therapeutic tool for both benign and malignant diseases in organs such as the kidney,prostate gland,lung,liver,and breast,and is particularly effective for unresectable tumors,offering less trauma,quick recovery,good tolerability,and symptom ***,cryoablation has its *** the past few years,cryoablation therapy has emerged as a new method for treating early *** treatment is minimally invasive,precise,and offers quick recovery,providing patients with a new treatment *** randomized studies are still limited,increasing evidence suggests its potential application in bladder cancer combined with transurethral resection(TURBT)or *** is not standard therapy for bladder *** decisions should be discussed by a multidisciplinary team of urologists,oncologists,and interventional physicians and require more randomized controlled trials to define patient selection criteria and treatment approaches.

关键词： bladder tumor transurethral resection of bladder tumors muscle-invasive bladder cancer non-muscle-invasive bladder cancer cryoablation

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Efficacy of immediate instillation combined with regular instillations of pirarubicin for Ta and T1 transitional cell bladder cancer after transurethral resection： a prospective, randomized, multicenter study

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Chinese Medical Journal 2013年第15期126卷 2805-2809页

作者： Li Ning-chen YE ZHANG-qun NA Yan-qun CUA THP Peking Univ Shougang Hosp Wujieping Urol Ctr Beijing 100144 Peoples R China Huazhong Univ Sci & Technol Tongji Hosp Tongji Med Coll Dept Urol Wuhan 430030 Hunan Peoples R China

Background Immediate intravesical instillation of chemotherapeutic agents after transurethral resection （TUR） of non- muscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly. This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin （THP~） as prophylaxis compared to regular instillations only after TUR operation. Methods This was a prospective, randomized, multi-center, clinical study. Patients diagnosed with non-muscle invasive bladder cancer （Ta and T1） pathologically and suitable for TUR were enrolled randomly into two groups. In the study group, the patients received intravesical instillation within 24-hour post TURBT, followed by regular intravesical therapy using 30 mg/50 ml of THP~ once a week for 8 weeks, and then once a month to 1 year postoperatively Among the patients. In the control group, patients received regular instillation only. Results A total of 403 patients were enrolled into this study from 26 institutions in China. Among the potients, 210 were enrolled into the study group and 193 were enrolled into the control group. At the median follow-up of 18 months, the recurrence rate was 7.8% in the study group, significantly lower than that in the control group （14.3%; P=0.042）. Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group （6.8%） than in the control group （14.0%; P=0.047）, although no significant differences were found in high-risk patients. Conclusion One immediate dose of THP 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence, especially in low and intermediate-risk patients.

关键词： pirarubicin instillation therapy non-muscle-invasive bladder cancer randomized clinical trial

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Holmium laser versus conventional transurethral resection of the bladder tumor

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Chinese Medical Journal 2013年第9期126卷 1761-1765页

作者： TENG Jing-fei WANG Kai YIN Lei QU Fa-jun ZHANG Dong-xu CUI Xin-gang XU Dan-feng Department of Urology Shanghai Changzheng Hospital Second Military Medical University Shanghai 200003 China Department of Urology General Hospital of Beijing Military Rejion Beijing 100700 China

Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.

关键词： non-muscle-invasive bladder cancer holmium laser resection of bladder tumor transurethral resection of bladder tumor

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