Non-muscle-invasive bladder carcinoma (NMIBC) should be treated with a transurethral resection of the bladder tumour (TURBT). The need for an adjuvant intravesical treatment is evaluated after TURBT and is based on various tumour characteristics. The aim of the adjuvant intravesical treatment is to reduce the number of recurrences and the risk of progression. This thesis consists of four individual FinnBladder (FB) studies that compared different intravesical regimens of chemo- and immunotherapy among patients with intermediate- or high-risk NMIBC. The present thesis analyses the long-term results of those studies. Patients in these studies belonged to the intermediate- or to the high-risk group of NMIBC. Patients in study I were treated with mitomycin C (MMC) or bacillus Calmette-Guérin (BCG) instillations for up to one year, whereas the patients in study II had one perioperative plus four weekly MMC instillations followed by MMC or alternating MMC and BCG instillations. The patients in study III had one perioperative MMC plus four weekly MMC instillations followed by either BCG or alternating BCG and interferon-α2b (IFN) instillations. The patients of study IV had one perioperative epirubicin (EPI) followed by BCG or combination of EPI and IFN. The follow-up times of the patients that were still alive were between 8.0 (study IV) and 19.4 years (study II). The median follow-up times of all patients were between 7.2 (study II) and 8.6 years (study III). In study I, we found that BCG significantly reduced the time to recurrence but had no effect on progression, disease specific survival or overall survival compared to MMC. In study II, we found no difference between the study groups (one perioperative MMC and four weekly MMC followed by BCG or alternating MMC and BCG). However, the risk of dying of BC appeared to be markedly lower than observed in the series of untreated patients. In study III, we found that one perioperative and four weekly MMC instillations followed by a monthly maintenance with BCG significantly reduced the probability of recurrence compared to maintenance with alternating BCG and IFN. In study IV, we found that one perioperative EPI administration followed by five weekly BCG and a 1- to 2-yr BCG maintenance treatment was significantly better in reducing recurrence than was a combination of EPI and IFN using the same schedule. Two subgroup analyses of our studies revealed a lower probability of recurrence in patients that had been treated with a single perioperative chemotherapy instillation compared to those without the single instillation. The risk of progression was very low in the best treatment groups of our studies after 10 years, which might question the benefit of a recommended life-long follow-up for all patients. Three out of four patients who progressed died of BC despite the relatively meticulous follow-up. Better methods are still needed to recognize the progression in NMIBC early enough to be able to lower the mortality of this disease.
|Status||Publicerad - 2016|
|MoE-publikationstyp||G5 Doktorsavhandling (artikel)|
- 3126 Kirurgi, anestesiologi, intensivvård, radiologi