To evaluate hyperthermic intravesical chemotherapy (HIVEC) using conductive heating and epirubicin in an optimized setting as an alternative to radical cystectomy in patients with recurrent non-muscle invasive bladder cancer (NMIBC) who have failed bacillus Calmette-Guérin (BCG) therapy. We retrospectively analyzed our prospectively recorded database of patients who underwent HIVEC between 11/2017 and 11/2022 at two Swiss University Centers. Cox regression analysis was used for univariate/multivariate analysis, and the Kaplan–Meier method for survival analysis. Of the 39 patients with NMIBC recurrence after failed BCG therapy, 25 (64%) did not recur within the bladder after a median follow-up of 28 months. The 12- and 24-month intravesical RFS were 94.8% and 80%, respectively. Extravesical recurrence developed in 14/39 (36%) of patients. Only 7/39 (18%) patients had to undergo radical cystectomy. Seven patients (18%) progressed to metastatic disease, with five of these (71%) having previously developed extravesical disease. No adverse events > grade 2 occurred during HIVEC. Device-assisted HIVEC using epirubicin in an optimized setting achieved excellent RFS rates in this recurrent NMIBC population at highest risk for recurrence after previously failed intravesical BCG therapy. Extravesical disease during or after HIVEC, however, was frequent and associated with metastatic disease and consecutively poor outcomes.
为评估在优化条件下采用导电加热与表柔比星进行的热灌注膀胱化疗（HIVEC）作为根治性膀胱切除术的替代方案，用于治疗卡介苗（BCG）治疗失败后复发的非肌层浸润性膀胱癌（NMIBC）患者，我们回顾性分析了2017年11月至2022年11月期间在瑞士两所大学医疗中心接受HIVEC治疗患者的前瞻性记录数据库。采用Cox回归分析进行单变量/多变量分析，并运用Kaplan-Meier法进行生存分析。在39例BCG治疗失败后NMIBC复发的患者中，中位随访28个月后，25例（64%）患者膀胱内未出现复发。12个月和24个月的膀胱内无复发生存率分别为94.8%和80%。14/39例（36%）患者出现膀胱外复发，仅7/39例（18%）患者需接受根治性膀胱切除术。7例（18%）患者进展为转移性疾病，其中5例（71%）此前已出现膀胱外病变。HIVEC治疗期间未发生＞2级的不良事件。在优化条件下使用表柔比星的设备辅助HIVEC，在这类既往膀胱内BCG治疗失败后复发风险极高的NMIBC患者群体中实现了优异的无复发生存率。然而，HIVEC期间或治疗后出现膀胱外病变的情况较为常见，且与转移性疾病及后续不良预后相关。
肿瘤(癌症)患者之家