Abstract
Objective
To evaluate the efficacy and safety of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IC) in non-muscle invasive bladder cancer (NMIBC) and identify the risk factors for recurrence and progression.
Methods
This is a retrospective cohort study of NMIBC patients in south China. Ninety-nine patients underwent IAC combined with transurethral resection of bladder tumor (TURBT) and IC, and 50 patients underwent TURBT plus IC without IAC. The 5-year outcomes of the two groups were compared. Cox regression was used to evaluate risk factors. Kaplan–Meier curves were used to assess the significant differences of recurrence-free survival and progression-free survival.
Results
At 5 years, IAC significantly reduced the recurrence of high-grade NMIBC, 54.5% (18/33) in the non-IAC group vs 30.5% (18/59) in the IAC group (p = 0.028). IAC significantly reduced the recurrence of high-risk NMIBC, 56.3% (18/32) in the non-IAC group vs 26.1% (18/69) in the IAC group (p = 0.007). IAC significantly reduced the recurrence of intermediate-risk NMIBC, 44.4% (8/18) in the non-IAC group vs 22.2% (6/27) in the IAC group (p = 0.030). Tumors numbering from 2 to 7 had the highest recurrence rate (18.1%, 27/149). In this aspect, there was a significantly lower recurrence rate in the IAC group (30.8%, 12/30) than in the non-IAC group (68.2%, 15/22) (p = 0.007). No significant difference was found in the progression rate between the two groups. Only two cases (2/99, 2.0%) in the IAC group showed progression. The results of univariate and multivariate analyses suggested that the number of tumors, grade and risk level were risk factors for recurrence. No difference was found with respect to gender, age, tumor diameter, and T category. In the Kaplan–Meier plot, recurrence-free survival was significantly associated with treatment strategies (p < 0.01). Recurrence-free survival was shorter in the non-IAC group (12.73 ± 7.56 months) than in the IAC group (17.88 ± 12.26 months).
Conclusions
Combined IAC is a promising procedure to prevent recurrence and may be useful to suppress progression in NMIBC patients. The independent risk factors for the recurrence of NMIBC were multifocal tumors, grade and risk level. Intra-arterial chemotherapy is an effective and safe procedure and may be a promising choice in areas where BCG is not available or for patients who are intolerant to BCG.
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Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request, but no information infringing on the privacy of the participants will be provided.
References
Arends TJ, Nativ O, Maffezzini M, de Cobelli O, Canepa G, Verweij F, Moskovitz B, van der Heijden AG, Witjes JA (2016) Results of a randomised controlled trial comparing intravesical chemohyperthermia with mitomycin C versus bacillus Calmette–Guérin for adjuvant treatment of patients with intermediate- and high-risk non-muscle-invasive bladder cancer. Eur Urol 69:1046–1052
Azuma H, Inamoto T, Ibuki N, Ubai T, Kotake Y, Takahara K, Kiyama S, Nomi H, Uehara H, Komura K, Yamamoto K, Narumi Y, Katsuoka Y (2010) Novel bladder preservation therapy for locally invasive bladder cancer: combined therapy using balloonoccluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation. Int J Oncol 37:773–785
Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Compérat E, Sylvester RJ, Kaasinen E, Böhle A, Palou Redorta J, Rouprêt M, European Association of Urology (2013) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 64:639–653
Babjuk M, Böhle A, Burger M, Capoun O, Cohen D, Compérat EM, Hernández V, Kaasinen E, Palou J, Rouprêt M, van Rhijn BW, Shariat SF, Soukup V, Sylvester RJ, Zigeuner R (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461
Bosschieter J, Nieuwenhuijzen JA, van Ginkel T, Vis AN, Witte B, Newling D, Beckers GMA, Moorselaar RJAV (2017) Value of an immediate intravesical instillation of mitomycin c in patients with non-muscle-invasive bladder cancer: a prospective multicentre randomised study in 2243 patients. Eur Urol 10:S0302-2838(17)30538-9
Brown GA, Matin SF, Busby JE, Dinney CP, Grossman HB, Pettaway CA, Munsell MF, Kamat AM (2007) Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology 70:252–256
Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, Kassouf W, Kiemeney LA, La Vecchia C, Shariat S, Lotan Y (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63:234–241
Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, van Andel G, Kirkels WJ, Silva FC, Oosterlinck W, Prescott S, Kirkali Z, Powell PH, de Reijke TM, Turkeri L, Collette S, Oddens J (2016) EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance bacillus Calmette–Guérin. Eur Urol 69:60–69
Catalona WJ, Hudson MA, Gillen DP, Andriole GL, Ratliff TL (1987) Risks and benefits of repeated courses of intravesical bacillus Calmette–Guerin therapy for superficial bladder cancer. J Urol 137:220–224
Chappidi MR, Kates M, Johnson MH, Hahn NM, Bivalacqua TJ, Pierorazio PM (2016) Lymph node yield and tumor location in patients with upper tract urothelial carcinoma undergoing nephroureterectomy affects survival: a US population-based analysis (2004–2012). Urol Oncol 34:531.e15–531.e24
Chen MK, Qin ZK, Zhou FJ, Han H, Liu ZW, Li YH, Yao K, Hou GL, Ye YL, Zhang ZL, Tu H, Zhang XQ, Lu KS, Yang ZW (2009) Intra-arterial chemotherapy is reliable in preventing high-risk superficial bladder cancer from recurrence and progression. J Chemother 21:681–686
Chen J, Yao Z, Qiu S, Chen L, Wang Y, Yang J, Li J (2013) Comparing intra-arterial chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone: a randomised prospective pilot study for T1G3 bladder transitional cell carcinoma after bladder-preserving surgery. Cardiovasc Intervent Radiol 36:1521–1526
Danesi DT, Arcangeli G, Cruciani E, Altavista P, Mecozzi A, Saracino B, Orefici F (2004) Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy: long term results. Cancer 101:2540–2548
Donald LL, Brent AB, Crawford ED, James EM, Peter S, Grossman HB, Thomas HS, Joseph ASJ, Jerry S, Michael FS, John DC, Charles AC (1991) A randomized trial of intravesical doxorubicin and immunotherapy with bacilli Calmette–Guerin for transitional-cell carcinoma of the bladder. N Engl J Med 325:1205–1209
Eapen L, Stewart D, Collins J, Peterson R (2004) Effective bladder sparing therapy with intra-arterial cisplatin and radiotherapy for localized bladder cancer. J Urol 172:1276–1280
Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, Wolf JS, Schellhammer PF (2007) Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 178:2314–2330
Han B, Liang S, Jing Y, Cui D, An X, Zou Q, Wei H, Xia S (2014) Organ preservation for muscle-invasive bladder cancer by preoperative intra-arterial chemotherapy and transurethral resection. Med Oncol 31:912
Kamat AM, Sylvester RJ, Böhle A, Palou J, Lamm DL, Brausi M, Soloway M, Persad R, Buckley R, Colombel M, Witjes JA (2016) Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the international bladder cancer group. J Clin Oncol 34:1935–1944
Knowles MA, Hurst CD (2015) Molecular biology of bladder cancer: new insights into pathogenesis and clinical diversity. Nat Rev Cancer 15:25–41
Kobayashi K, Furukawa A, Takahashi M, Murata K (2003) Neoadjuvant intra-arterial chemotherapy for locally advanced uterine cervical cancer: clinical efficacy and factors influencing response. Cardiovasc Interv Radiol 26:234–241
Marko Babjuka A, Bo¨hle M, Burger et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461
Marttila T, Järvinen R, Liukkonen T, Rintala E, Boström P, Seppänen M, Tammela T, Hellström P, Aaltomaa S, Leskinen M, Raitanen M, Kaasinen E, FinnBladder Group (2016) Intravesical Bacillus Calmette–Guérin versus combination of epirubicin and interferon-α2a in reducing recurrence of non-muscle-invasive bladder carcinoma: FinnBladder-6 Study. Eur Urol 70:341–347
Miyake M, Gotoh D, Shimada K, Tatsumi Y, Nakai Y, Anai S, Torimoto K, Aoki K, Tanaka N, Konishi N, Fujimoto K (2015) Exploration of risk factors predicting outcomes for primary T1 high-grade bladder cancer and validation of the Spanish Urological Club for Oncological Treatment scoring model: long-term follow-up experience at a single institute. Int J Urol 22:541–547
Miyake M, Fujimoto K, Hirao Y (2016) Active surveillance for nonmuscle invasive bladder cancer. Investig Clin Urol 57:S4–S13
Miyanaga N, Akaza H, Okumura T, Sekido N, Kawai K, Shimazui T, Kikuchi K, Uchida K, Takeshima H, Ohara K, Akine Y, Ita Y (2000) A bladder preservation regimen using intra-arterial chemotherapy and radiotherapy for invasive bladder cancer: a prospective study. Int J Urol 7:41–48
Mori K, nomata K, noguchi M, Eguchi J, Hayashi n, Kanetake H (2007) Long-term follow up of patients with invasive bladder carcinoma receiving combined cisplatin-based intra-arterial chemotherapy and radiotherapy. Int J Urol 14:591–594
Nepple KG, Lightfoot AJ, Rosevear HM, O’Donnell MA, Lamm DL, Bladder Cancer Genitourinary Oncology Study Group (2010) Bacillus Calmette–Guerin with or without interferon alpha-2b and megadose versus recommended daily allowance vitamins during induction and maintenance intravesical treatment of nonmuscle invasive bladder cancer. J Urol 184:1915–1919
Reis LO, Moro JC, Ribeiro LF, Voris BR, Sadi MV (2016) Are we following the guidelines on non-muscle invasive bladder cancer? Int Braz J Urol 42:22–28
Sun F, Zhao R, Zhu Y, Cui D, Wang X, Han B, Liang S, Liu H, Sun X, Zhao F, Xu D, Xia S (2017) A prospective comparison of intra-arterial chemotherapy combined with intravesical chemotherapy and intravesical chemotherapy alone after transurethral resection with a thulium laser in high-risk non-muscle invasive bladder cancer. Cancer Chemother Pharmacol 79:1099–1107
Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC-GUCG risk tables: a combined analysis of 2596 patients from seven EORTC-GUCG trials. Eur Urol 49:466–465 (discussion 475–7)
Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A, European Association of Urology (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65:778–792
Woldu SL, Bagrodia A, Lotan Y (2017) Guideline of guidelines: non-muscle-invasive bladder cancer. BJU Int 119:371–380
Zhang Y, Xie L, Chen T, Xie W, Wu Z, Xu H, Xing C, Sha N, Shen Z, Qie Y, Liu X, Hu H, Wu C (2016) Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study. Onco Targets Ther 9:605–611
Zhou FJ, Yu SL, Li YH, Liu ZW, Xiong YH, Wu PH, Han H, Qin ZK (2009) Intra-arterial chemotherapy with gemcitabine and cisplatin for patients with recurrence of transitional cell carcinoma confined to the pelvis. J Chemother 21:91–97
Acknowledgements
The project was supported by the National Natural Science Foundation of China (no. 81102270), Guangdong Natural Science Foundation (no. 2016A030313217) and Guangdong Natural Science Foundation (no. 2016A030313206).
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FL, YW, and JL conceived and designed the research; YW and FL prepared the manuscript; LS, WC and WF collected and analyzed the data; YL and WC performed the radiologic evaluation; YL and YZ conducted the statistical analysis. All authors have read and approved the final manuscript.
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The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the first affiliated hospital of Sun Yat-sen University (permission number: 475109).
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Lian, F., Chen, W., Liu, Y. et al. Intra-arterial chemotherapy combined with intravesical chemotherapy is effective in preventing recurrence in non-muscle invasive bladder cancer. J Cancer Res Clin Oncol 145, 1625–1633 (2019). https://doi.org/10.1007/s00432-019-02900-8
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DOI: https://doi.org/10.1007/s00432-019-02900-8