Intravesical Instillation Of Pirarubicin Combined With BCG In The Prophylaxis Of Local Recurrence Of The Bladder Cancer And The Expression Of COX-2 In Bladder Carcinomas And It's Effects On Proliferation And Angiogenesis

PERIOPERATIVE SINGLE DOSE INSTILLATION OF EPIRUBICIN PLUS BACILLUS CALMETTE-GUERIN VERSUS BACILLUS CALMETTE-GUERIN ALONE FOR SUPERFICIAL BLADDER CARCINOMA: COMPARATIVE STUDIES ON RECURRENCE AND TOXICITYPurpose: This study was designed to find a new therapeutic modality that may have better efficacy than bacillus Calmette-Guerin (BCG) alone to prevent recurrence of superficial transitional cell carcinoma of the bladder.Materials and Methods: Between March 2000 and September 2003 a prospective randomized trial was conducted on 71 patients with stages pTa and pT1 bladder transitional cell carcinoma to compare the prophylactic efficacy and toxicity of perioprative single dose instillation of epirubicin plus BCG (group 1) versus BCG alone (group 2). Group 1 comprised 34 patients who received single dose 40mg epirubicin in three days after operation and followed by 100mg BCG. Treatment was continued for 6 weeks followed by 12 monthly instillations, while 37 patients in group 2 received 100 mg BCG only.Results: Among the 71 patients (52 men and 19 women, mean age 54 years) mean followup was 18 months (range 12 to 25). Patients assigned single dose 40mg epirubicin instillations had lower recurrence rates than BCG instillations only. The incidence and severity of toxicity were not significantly different between the 2 groups.Conclusions: Our study indicates that perioperative single dose 40mg epirubicin plus six weekly and maintenance BCG instillations is more effective than BCG instillations alone, but have equal toxicity. THE DIFFERENCE OF URINARY INTERLEUKIN-8 LEVER BETWEEN INSTILLATION OF EPIRUBICIN PLUS BACILLUS CALMETTE-GUERIN AND BACILLUS CALMETTE-GUERIN ALONEPurpose: We want to know the change of urinary interleukin-8 lever after agent intravesical instillation, whether there is difference between epirubicin-BCG and BCG alone. Furthermore we want to evaluate the predictive value of urinary cytokine levels of interleukin (IL) 8 for response in patients receiving intravesical therapy for prevention of recurrences of superficial bladder cancer.Materials and Methods: A total of 62 patients with superficial bladder cancer underwent perioperative single dose 40mg epirubicin plus six weekly and maintenance BCG instillations or current standard BCG instillations. Voided urine samples were collected before operation, 2 weeks after operation and first 2 hours after BCG instillations 1 and 6. Urine samples were centrifuged at 1,500 rpm for 8 minutes, and the supernatant was stored at -2OC. An enzymelinked immunosorbent assay technique was used to measure urinary IL-8 levels. Patients were followed with cystoscopy and urinary cytology every 3 months to detect bladder tumor recurrence.Results: The median urinary IL-8 levels were greater in subjects with TCC than in healthy subjects, and BCG administration made it's lever elevating significantly, but this change had no relationship with epirubicin instillation or not. Median IL-8 lever during the first 2 hours for the patients with recurrence was 213.75±104.23pg/ml. Median IL-8 lever during the first 2 hours in patients without recurrence was 670. 85±191.74pg/ml .50 (98.04%) had no recurrent disease who greater than 400pg/ml, but 7(63.64%) had recurrence who lower than 400pg/ml. Conclusions: In this study we confirmed the change of urinary IL-8 levels after BCG administration, and fended that perioperative epirubicin instillation has no effect on immunoresponse induced by BCGIL-8 expression in the urine during the first 2 hours after BCG instillation for superficial bladder cancer predict freedom of disease. The Expression of COX-2 in Transitional Cell Carcinoma of Bladder Carcinomas and It's Effects on Proliferation and AngiogenesisPurpose: To investigate the expression of COX-2 mRNA and protein in human transitional cell carcinoma of bladder and it's effects on proliferation of tumor cell and angiogenesis.Materials and Methods: The expression of COX-2mRNA was examined by revers transcriptase-polymerase chain reaction(RT—PCR) and the protein expression of COX-2, PCNA and F₈ was examined by immunohistochemical staining.Results: Using RT-PCR, 13 of 15 frozen specimens of bladder cancer were shown to express COX-2 mRNA, but none of 9 specimens from normal bladder mucosa was positive expression. The positive rate of COX-2 protein was 56.67% in BTCC. The MVD and PCNALI in the tissues with positive COX-2 expression were significantly higher than the controls.Conclusions: The expression of COX—2 was enhanced in human BTCC, and it may stimulate angiogenesis and proliferation of tumor cells. It indicates that COX—2 may play a key role in the development and progression of BTCC.