Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C
Abstract Background Intravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare...
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | BMC Urology |
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| Online Access: | http://link.springer.com/article/10.1186/s12894-018-0408-6 |
| _version_ | 1818193844219412480 |
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| author | Andrew T. Lenis Kian Asanad Maher Blaibel Nicholas M. Donin Karim Chamie |
| author_facet | Andrew T. Lenis Kian Asanad Maher Blaibel Nicholas M. Donin Karim Chamie |
| author_sort | Andrew T. Lenis |
| collection | DOAJ |
| description | Abstract Background Intravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT. Methods We retrospectively reviewed records of patients with NMIBC at our institution in 2012–2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed. Results 205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28–6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20–0.59) and MMC (HR 0.43, 95% CI: 0.25–0.75) were associated with decreased risk. Conclusions Postoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone. |
| first_indexed | 2024-12-12T00:52:51Z |
| format | Article |
| id | doaj.art-227a045a1d7e4f1a8646a0ac743a226b |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-12-12T00:52:51Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-227a045a1d7e4f1a8646a0ac743a226b2022-12-22T00:43:58ZengBMCBMC Urology1471-24902018-10-011811910.1186/s12894-018-0408-6Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-CAndrew T. Lenis0Kian Asanad1Maher Blaibel2Nicholas M. Donin3Karim Chamie4David Geffen School of Medicine at the University of California Los AngelesDavid Geffen School of Medicine at the University of California Los AngelesRiverside School of Medicine, University of CaliforniaDavid Geffen School of Medicine at the University of California Los AngelesDavid Geffen School of Medicine at the University of California Los AngelesAbstract Background Intravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT. Methods We retrospectively reviewed records of patients with NMIBC at our institution in 2012–2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed. Results 205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28–6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20–0.59) and MMC (HR 0.43, 95% CI: 0.25–0.75) were associated with decreased risk. Conclusions Postoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone.http://link.springer.com/article/10.1186/s12894-018-0408-6Bladder cancerTherapeutic irrigationMitomycin-CRecurrenceOutcome assessment |
| spellingShingle | Andrew T. Lenis Kian Asanad Maher Blaibel Nicholas M. Donin Karim Chamie Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C BMC Urology Bladder cancer Therapeutic irrigation Mitomycin-C Recurrence Outcome assessment |
| title | Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C |
| title_full | Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C |
| title_fullStr | Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C |
| title_full_unstemmed | Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C |
| title_short | Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C |
| title_sort | continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical mitomycin c |
| topic | Bladder cancer Therapeutic irrigation Mitomycin-C Recurrence Outcome assessment |
| url | http://link.springer.com/article/10.1186/s12894-018-0408-6 |
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