Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study

Abstract

ObjectiveThe management of stage 1 and grade 3 (T1G3) bladder cancer continues to be controversial. Although the transurethral resection of bladder tumor (TURBT) followed by intravesical chemotherapy is a conservative strategy for treatment of T1G3 bladder cancer, a relatively high risk of tumor recurrence and progression remains regarding the therapy. This study aimed to compare the efficacy of intravenous chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for T1G3 bladder cancer after TURBT surgery.MethodsWe retrospectively reviewed the cases of 457 patients who were newly diagnosed with T1G3 bladder urothelial carcinoma between January 2009 and March 2014. After TURBT, 281 patients received intravesical chemotherapy alone, whereas 176 patients underwent intravesical chemotherapy in combination with intravenous chemotherapy. Tumor recurrence and progression were monitored periodically by urine cytology and cystoscopy in follow-up. Recurrence-free survival and progression-free survival of the two chemotherapy strategies following TURBT were analyzed. Univariable and multivariable Cox hazards analyses were performed to predict the prognostic factors for tumor recurrence and progression.ResultsThe tumor recurrence rate was 36.7% for patients who received intravesical chemotherapy alone after TURBT, compared with 19.9% for patients who received intravenous chemotherapy combined with intravesical chemotherapy after TURBT (P<0.001). The progression rate was 10.6% for patients who underwent intravesical chemotherapy alone and 2.3% for patients who underwent the combined chemotherapies (P=0.003). Kaplan–Meier curves showed significant differences in recurrence-free survival and progression-free survival between the two treatment strategies, with a log-rank P-value of <0.001 and 0.003, respectively. Multivariable analyses revealed that intravenous chemotherapy was the independent prognostic factor for tumor recurrence and progression in the cohort.ConclusionIntravenous chemotherapy combined with intravesical chemotherapy offers a better oncologic outcome than the intravesical chemotherapy alone for patients with T1G3 bladder urothelial carcinoma after TURBT, and it may be considered as a new therapy strategy for T1G3 bladder cancer.

Efficacy of Intra-Arterial Plus Intravesical Chemotherapy for High-Risk Non-Muscle-Invasive Bladder Cancer: A Pooled Analysis

“…We noticed, in this analysis, six studies used IVC alone in the monotherapy group ( Chen et al, 2013 ; Huang et al 2019a ; Huang et al 2019b ; Zhang et al, 2016 ; Sun et al, 2017 ; Huang et al, 2020 ). Therefore, we made this subgroup analysis to compare the efficacy of IAC + IVC with IVC alone.…”

“…A total of 1,539 original publications were retrieved through systematic search, among them 514 were excluded as repeated records. After manual selection for titles, abstracts, and full-text articles, we enrolled seven eligible studies involving 1,247 patients who are pathologically diagnosed with NMIBC after bladder-preserving surgery ( Chen et al, 2013 ; Lian et al, 2019 ; Huang et al, 2019b ; Huang et al, 2019a ; Sun et al, 2017 ; Zhang et al, 2016 ; J; Huang et al, 2020 ). The detailed process of the studies’ selection was shown in Figure 1 .…”

“…Totally, all seven studies reported the tumor recurrence rate ( Chen et al, 2013 ; Lian et al, 2019 ; Huang et al, 2019b ; Huang et al, 2019a ; Sun et al, 2017 ; Zhang et al, 2016 ; J. Huang et al, 2020 ; Chen et al, 2013 ).…”

“…Tumor progression rate results were extracted in six enrolled studies ( Huang et al, 2020 ; Huang et al 2019b ; Huang et al 2019a ; Sun et al, 2017 ; Zhang et al, 2016 ; J.; Chen et al, 2013 ), 10.6% (54/511) patients in IAC + IVC group had progression compared with 18.3% (135/736) in the monotherapy groups. The pooled OR for this result was 0.51 (95% CI: 0.36–0.72; p < 0.05).…”

“…IAC has shown its efficacy in reducing disease recurrence and progression for MIBC, which would be a remedial treatment for MIBC patients following TURBT ( Liang et al, 2015 ). In recent years, the IAC + IVC regimen after TURBT in T1-staged Grade 3 (T1G3) high-risk NMIBC patients was reported to reduce the risk of recurrence and progression in several studies ( Huang et al, 2019b ; Zhang et al, 2016 ; Chen et al, 2013 ). However, a retrospective study found that IAC + IVC may fail to decrease progression in the NMIBC patients ( Lian et al, 2019 ).…”