Clinical Research Of Preventing The Recurrence Of Bladder Carcinoma By Low Dose Mitomycin C During Surgery

Objective To detect the therapeutic efficacy and feasibility of low dose Mitomycin C (MMC) for preventing recurrence and progression of bladder carcinoma (BC) by injecting into the tumour base together with perfusing inside bladder instantly or together with injecting bladder mucous membrane widespreadly during surgery.Methods A toal of 73 cases (56 male and 17 females;mean age,52 years;age range 17~73 years)which had initial bladder transitional cell cancer (BTCC) were all treated with bladder-sparing approach. The overall cases were divided randomly into three groups:Group A,n=27;Group B,n=22;Group C,n=24. Group A and Group B of 49 cases were taken separately the therapy group,Group C of 24 cases was taken for control group.Group A of 27 cases was treated by low dose MMC (MMC 10mg was added to physiological saline 100ml ,namely,0.10g/L) injecting into the tumour base and perfusing inside bladder instantly during surgery ; Group B of 22 cases was received the therapy of the same low dose MMC which was injected into the tumour base and injected widespreadly into the bladder mucous membrane during surgery. then MMC at doses of 20mg in 50 ml physiological saline (0.40g/l) was perfused regularly inside bladder postoperatively in A,B two groups.Group C of 24 cases was only perfused regularly with MMC at doses of 20 mg in 50 ml physiological saline (0.4g/l) inside bladder after surgery. Follow up ranged from 12 to 60 months,with a mean follow-up of 36 months.The recurrence rate (RR) and progression rate (PR) were counted through the way to inject the low dose MMC into the tumour base and perfuse it inside bladder instantly during operation of BC (Group A) ,and inject the low dose MMC into the tumour base and inject widespreadly under the bladder mucous membrane during surgery(Group B),compared with the RR and PR of regular intravesical instillation of MMC(20mg) alone in the same period after operation(Group C).The original tumour stage, grade and their association with recurrence and progression of this type of BTCC were retrospectively analyzed.Resultsâ‘ The entire group recurs 14 cases,the overall RR was 19.18%(14/73). Group A recurs 3 cases,the average recurrence time was 15.67 months, the RR was 11.11%(3/27);Group B recurs 2 cases,the average recurrence time was 17.00 months, the RR was 9.09%(2/22);Group C recurs 9 cases, the average recurrence time was 11.00 months,the RR was 37.50%(9/24),it does not have significant difference between Group A and B(P>0.05). But the RR in patients of Group A and B reduces obviously, compared with that of Group C,there were remarkable difference among them(P<0.05).â‘¡For the recurrence of Group A,there were 1 case of G2T2, 2 cases of G3 (1 case of T2, 1 case of T3); for the recurrence of Group B,1 case of G2T2, 1 case of G3 T2 ; for the recurrence of Group C,4 cases of G2 (2 cases of T2, 2 cases of T3), 5 cases of G3 (2 cases of T2 , 3 cases of T3). The pathology grades of altogether 4 recurrence cases in these three groups were progressed .among them, the pathology grade of 1 case progressed by G2 to G3 in Group A; the pathology grades of 3 cases progressed in Group C, namely, the pathology grade of 1 case progressed by G1 to G2 ,and the pathology grades of 2 cases by G2 to G3, it does not have significant difference among them(P>0.05). In three groups, they altogether had 10 cases to have the myo-infiltration, 1 case of Group B, 3 cases of Group C,infiltrate to the bladder shallow myo-level ,that is, clinical stage T2; 1 case of Group A, 5 cases of Group C, infiltrate to the deep myo-level,say,clinical stage T3. The PR of clinical stages had not remarkable difference between Group A and B (P>0.05), the PR of clinical stages had statistical significance between Group A and C, and between Group B and C(P<0.05).â‘¢For tumor site,in Group A, 1 case (1/27) recurs in situ recurrence, 2 cases (2/27) recurs ecotopic recurrence; in Group B , 1 case (1/22) recurs in situ recurrence, 1 case (1/22) recurs ecotopic recurrence; in Group C, 8 cases (8/24) recurs in situ recurrence, 1 case (1/24) recurs ecotopic recurrence.The difference of ecotopic recurrence was no statistically significance among Group A,B and C (P>0.05). The RR of in situ recurrence in Group A or Group B was significantly higher than that of it in Group C, there was a very statistically significant difference between each two groups(P<0.05).â‘£In treatment period, all cases had 39 cases to have the partial response. In Group A of 15 cases(20.55% ,15/73),â… Level 12 cases,â…¡Level 3 cases; In Group B of 13 cases (17.81% ,13/73),â… Level 10 cases,â…¡Level 3 cases; In Group C of 11 cases (15.07% ,11/73),â… Level 10 cases,â…¡Level 1 case.There was not any serious complication,such as the bladder mucous membrane necrosis, the marrow suppression ,and so on.Conclusion The results revealed that injecting into the tumour base combining with perfusing inside bladder instantly by low dose MMC, i.e,10mg, 0.10g/L, has the similar effect to that combined with injecting widespreadly into bladder mucous membrane by the same low dose MMC during surgery for preventing recurrence and progression of BC, and has better effectiveness than perfusing MMC regularly inside bladder alone after operation.The two ways are more reliable, safe and suitable especially for patients with BC of clinical stages Taand T1 in lower or middle risk, and providing greater chance of bladder-sparing approach for patients with BC of clinical stages T2 and T3. The agents may be the alternative surgical method for treating patients with BC.