Efficacy Analysis Of Three Bladder Instillation Drugs On Preventing Recurrence Of Non-muscle Invasive Bladder Cancer

Objective: To compare the efficacy and safety of intravesical instillation of epirubicin,pirarubicin and gemcitabine in preventing tumor recurrence after transurethral resection of bladder tumor in patients with intermediate-or high-risk non-invasive bladder cancer.Methods: This study retrospectively analyzed patients with the intermediate-or high-risk non-muscle invasive bladder cancer who received regular intravesical therapies of epirubicin,pirarubicin or gemcitabine after transurethral resection of bladder tumors at the Second Hospital of Lanzhou University from January 1,2013 to December 31,2017,and patients were divided into epirubicin group(group EPI),pirarubicin group(group THP)and gemcitabine group(group GEM)according to different intravesical therapies.Through clinical data collection and telephone follow-up,all patients were counted for tumor recurrence and adverse reactions after bladder perfusion therapy,and statistical software SPSS 25.0 was used to analyze and compare the collected data.Result: A total of 175 intermediate-and high-risk patients with non-muscle invasive bladder cancer were included in the study,including 60 patients in the EPI group,60 patients in the group THP,and 55 patients in the group GEM.Among the patients,there were 139 males and 36 females,with ages ranging from 27 to 85 years,with an average age of 62.67 years.According to the risk of tumor recurrence and prognosis,the three groups of patients are divided into intermediate-risk and high-risk to evaluate tumor recurrence after intravesical therapies.There were 25 intermediate-risk patients in the group EPI,30 in the group THP,and 25 in the group GEM.The 1-year recurrence rate of intermediate-risk patients in the group EPI,group THP,and group GEM was 12.0%(3/25),13.3%(4/30),8.0%(2/25),respectively,with no statistically significant difference between the three groups(P=0.907);The 2-year recurrence rates of patients with intermediate-risk bladder cancer in group EPI,group THP,and group GEM were respectively 20.0%(5/30),23.3%(7/24),16.0%(4/25)and there was no statistically significant difference between three groups(P=0.795).Comparing the recurrence-free survival of recurrent patients in the three groups of intermediate-risk patients,the recurrence-free survival of recurrent patients in the group EPI was 13.20±6.57 months,and the recurrence-free survival of the recurrent patients in the group THP was 12.57±8.12 months,and the recurrence-free survival of the recurrent patients in the group GEM was 13.75±2.06 months,and there was no statistically significant difference between the three groups(P=0.960).There were 35 high-risk patients in the group EPI,30 high-risk patients in the group THP,and 30 high-risk patients in the group GEM.The 1-year recurrence rate of patients with high-risk bladder cancer in the group EPI,group THP,and group GEM were respectively 28.6%(10/35),26.7%(8/30),13.3%(4/30),and there was no statistically significant difference between the three groups(P=0.300);The 2-year recurrence rate of three groups of high-risk bladder cancer patients in the group EPI,group THP,and group GEM were respectively 45.7%(16/30),40.0%(12/30)and 30.0%(9/30),and there was no statistically significant difference between the three groups(P=0.428);Comparing the recurrence-free survival of recurrent patients in the three groups of high-risk patients,the recurrence-free survival of recurrent patients in the group EPI was 10.75±5.80 months,and the recurrence-free survival of the recurrent patients in the group THP was 11.92±6.04 months,and the recurrence-free survival of the recurrent patients in the group GEM was 12.11±7.04 months,and there was no significant difference between the three groups(P=0.830).Comparing the incidence of adverse reactions during intravesical treatment in the three groups,the incidence of adverse reactions in the group EPI was 35.0%(21/60),the incidence of adverse reactions in the group THP was 36.7%(22/60),and the incidence of adverse reactions in the group GEM was 14.6%(8/55),there was significant difference between the three groups(P=0.016);Among them,there was statistical significant difference in the adverse reactions incidence between group GEM and group EPI(P<0.05);there was statistical significant difference in the adverse reactions incidence between group GEM and group THP(P<0.05);there was no significant difference between group EPI and group THP(P>0.05);Comparing the incidence of bladder irritation during intravesical treatment between the three groups,the difference among them was statistically significant(P=0.023);There was significant difference in the incidence of bladder irritation between group GEM and group EPI(P < 0.05);There was significant difference in the incidence of bladder irritation between the group GEM and the group THP(P<0.05).There was no significant difference in the incidence of bladder irritation between the group EPI and the group THP(P>0.05);There was no significant difference in the incidence rate of other adverse reactions among the three groups(P > 0.05).Conclusion: For patients with intermediate-or high-risk non-muscle invasive bladder cancer,there was no significant difference in the efficacy of intravesical instillation of epirubicin,pirubicin,and gemcitabine in preventing postoperative tumor recurrence.Intravesical gemcitabine had a lower rate of adverse reactions than epirubicin and pirarubicin,and the incidence of bladder irritation during intravesical gemcitabine therapy was lower than that of epirubicin and pirarubicin.There was no significant difference in the incidence of adverse reactions between intravesical epirubicin and pirarubicin.