Is switching intravesical chemotherapeutic agent beneficial in short-term recurrent high-risk non-muscle- invasive bladder tumors? A 5-year retrospective study

Abstract

Abstract Objective: To assess whether switching intravesical chemotherapeutic agent is beneficial in short-term recurrent high-risk non-muscle-invasive bladder cancer (NMIBC) after failure of previous intravesical therapy. Materials and methods: From June 2010 to October 2015, 215 patients with NMIBC, who had tumor recurrence within one year of first-line drugs for Intravesical chemotherapy (IVC), were assigned to two groups. After a second time complete TUR treatment, we immediately changed the intravesical instillation agent for 107 patients (group A), whereas the other 98 patients continued to use their original intravesical instillation agent (group B - control group). All patients received an immediate instillation of epirubicin (EPI), gemcitabine (Gem) or hydroxycamptothecin (HCPT) after TURBT and followed by regularly induction plus maintenance instillations. Recurrence rate and progression rate were assessed by Chi-square test, while recurrence-free survival and progression-free survival were calculated using the Kaplan–Meier method. Results: In this study, the recurrence rate was 49.5% (53/107) in group A and 50.0% (49/98) in group B, while progression rate was 18.7% (21/107) in group A and 23.5% (23/98) in group B. Neither recurrence nor progression rates showed any significant differences between the two groups. Median progression interval between two groups were 24 months and 17 months, respectively (p=0.044). Average progression time between two groups were 28.7months and 19.3 months, respectively (p=0.035). In the Kaplan–Meier plot, no difference was found with respect to recurrence-free survival and progression-free survival. Moreover, univariate analysis suggested that only tumor grade could be an independent risk factor related to recurrence (HR = 0.632; 95% CI 0.425-0.942; p = 0.024), while the presence of carcinoma in situ may be an independent risk factor related to progression (HR=0.159; 95% CI 0.037-0.683; p=0.013). Conclusions: Switching IVC agent can significantly prolong time of progression in patients with short-term recurrent high-risk NMIBC who are unavailability or unsuitability for BCG instillation. Furthermore, the finding may provide a new basis for drug selection in combination IVC.