Abstract

BACKGROUND:

EAU guidelines recommend a single instillation (SI) of intravesical chemotherapy (e.g. Mitomycin C) within 24 hours after transurethral resection of a bladder tumour (TURBT) in patients with low- to intermediate risk non-muscle invasive bladder cancer without (suspected) bladder perforation or bleeding requiring bladder irrigation. However, remarkable variation exists in the use of SI. The risk of severe complications is likely to contribute to this variation, but evidence is limited.

OBJECTIVE:

To investigate the absolute severe complication and mortality risk after SI in low- and intermediate risk bladder cancer.

METHODS:

In this observational, historic cohort study, data on 25,567 patients diagnosed with TaG1G2 urothelial bladder carcinoma (UBC) between 2009 and 2018 who underwent TURBT were collected from the Netherlands Cancer Registry. Data were supplemented with information on cause of death and severe complications after cancer treatment by re-examining the electronic health records and the 14-day complication risk and the 30-day mortality risk were evaluated.

RESULTS:

On average, 55% of patients had a SI after TURBT, varying from 0–>80% between hospitals. The 30-day mortality risk was 0.02% and the 14-day risk of severe complications was 1.6%.

CONCLUSIONS:

As the absolute risk of mortality and severe complications is very low, SI after TURBT can be considered a safe treatment in patients with low- to intermediate UBC without contraindications for SI. These results imply that a part of eligible patients is denied effective treatment.

中文翻译：

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TaG1G2 膀胱尿路上皮癌患者术后单次膀胱灌注化疗后严重并发症的风险较低

 抽象的

 背景：

EAU指南建议，对于无（疑似）膀胱穿孔的低至中危非肌层浸润性膀胱癌患者，经尿道膀胱肿瘤切除术（TURBT）后24小时内进行单次膀胱内化疗（例如丝裂霉素C）灌注（SI）或需要膀胱冲洗的出血。然而，SI 的使用存在显着差异。严重并发症的风险可能导致这种差异，但证据有限。

 客观的：

旨在调查低风险和中风险膀胱癌 SI 后的绝对严重并发症和死亡风险。

 方法：

在这项观察性、历史性队列研究中，从荷兰癌症登记处收集了 2009 年至 2018 年间诊断为 TaG1G2 尿路上皮膀胱癌 (UBC) 并接受 TURBT 的 25,567 名患者的数据。通过重新检查电子健康记录，补充癌症治疗后死亡原因和严重并发症的信息，并评估14天并发症风险和30天死亡风险。

 结果：

平均而言，55% 的患者在 TURBT 后出现 SI，各医院之间的差异为 0->80%。 30天死亡风险为0.02%，14天严重并发症风险为1.6%。

 结论：

由于死亡和严重并发症的绝对风险非常低，对于没有 SI 禁忌症的低至中度 UBC 患者，TURBT 后 SI 可以被认为是一种安全的治疗方法。这些结果意味着一部分符合条件的患者无法得到有效的治疗。