Because of the failure, shortage and related toxicities of Bacillus Calmette-Guérin (BCG), the other intravesical chemotherapy drugs are also widely used in clinical application. Gemcitabine and anthracycline antibiotics (epirubicin and pirarubicin) are widely used as first-line or salvage therapy, but which drug is better is less discussed. A total of 124 primary NMIBC patients administered intravesical therapy after transurethral resection of bladder tumor (TURBT) at Nanjing Drum Tower hospital from January 1996 to July 2018. After TURBT, all patients accepted standard intravesical chemotherapy. Recurrence was defined as the occurrence of a new tumor in the bladder. Progression was defined as confirmed tumor invading muscular layer. Treatment failure was defined as need for radical cystectomy (RC), systemic chemotherapy and radiation therapy. Of the 124 patients who underwent intravesical chemotherapy, 84 patients were given gemcitabine, 40 patients were given epirubicin or pirarubicin, with mean follow-up times (mean ± SD) of (34.8 ± 17.9) and (35.9 ± 22.1) months respectively. The clinical and pathological features of patients show no difference between two groups. Recurrence rate of patients given gemcitabine was 8.33% (7 out of 84), the recurrence rate was 45% (18 out of 40) for epirubicin or pirarubicin (P < 0.0001). The progression rates of gemcitabine, anthracycline antibiotics groups were 2.38% (2 out of 84) and 20% (8 out of 40), respectively (P < 0.001). The rate of treatment failure is 8.33% (7 out of 84) and 25% (10 out of 40), respectively (P = 0.012). Gemcitabine intravesical chemotherapy group was significantly related to a lower rate of recurrence (HR = 0.165, 95% CI 0.069–0.397, P = 0.000), progression (HR = 0.160, 95% CI 0.032–0.799, P = 0.026) and treatment failure (HR = 0.260, 95% CI 0.078–0.867, P = 0.028). In conclusion, gemcitabine intravesical chemotherapy group was significantly related to a lower rate of recurrence, progression and treatment failure. Gemcitabine could be considered as a choice for these patients who are not suitable for BCG.

中文翻译：

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吉西他滨和蒽环类抗生素预防浅表性膀胱癌复发的比较

由于卡介苗芽孢杆菌（BacillusCalmette-Guérin，BCG）的失败，缺乏和相关毒性，其他膀胱内化疗药物也被广泛用于临床。吉西他滨和蒽环类抗生素（埃比霉素和吡柔比星）被广泛用作一线或挽救性疗法，但哪种药物更好，则讨论较少。自1996年1月至2018年7月，在南京鼓楼医院经尿道膀胱肿瘤切除术（TURBT）后，共有124例原发NMIBC患者接受了膀胱内治疗。在TURBT之后，所有患者均接受了标准的膀胱内化疗。复发定义为在膀胱中出现新的肿瘤。进展被定义为证实的肿瘤侵袭肌层。治疗失败定义为需要进行根治性膀胱切除术（RC），全身化疗和放射治疗。在124例接受腔内化疗的患者中，有84例接受了吉西他滨治疗，40例接受了表柔比星或吡柔比星治疗，平均随访时间（平均值±标准差）分别为（34.8±17.9）和（35.9±22.1）个月。两组患者的临床和病理特征无差异。吉西他滨的患者复发率为8.33％（84例中有7例），表柔比星或吡柔比星的复发率为45％（40例中有18例）（P <0.0001）。吉西他滨，蒽环类抗生素组的进展率分别为2.38％（84个中的2个）和20％（40个中的8个）（P <0.001）。治疗失败率分别为8.33％（84个中的7个）和25％（40个中的10个）（P = 0.012）。吉西他滨膀胱内化疗组与较低的复发率显着相关（HR = 0.165，95％CI 0.069-0.397，P = 0.000），进展（HR = 0.160，95％CI 0.032-0.799，P = 0.026）和治疗失败（HR = 0.260，95％CI 0.078-0.867，P = 0.028）。总之，吉西他滨膀胱内化疗组与较低的复发率，进展和治疗失败显着相关。对于这些不适合卡介苗的患者，吉西他滨可以考虑作为一种选择。