Efficacy of bladder perfusion of alternating hydroxycamptothecin and gemcitabine combined with low-dose tuberculin in the treatment of non-muscle invasive bladder cancer after TURBT.

Purpose: To evaluate the clinical efficacy and safety of alternating sequential bladder perfusion of hydroxycamptothecin (HCPT) combined with low-dose tuberculin (BCG), and gemcitabine (GEM) combined with low-dose BCG in the treatment of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). Methods: A total of 170 patients with primary NMIB urothelial carcinoma were retrospectively collected from October 2014 to December 2016 and randomly divided into two groups with 85 cases in each group, in which 85 cases were given alternating bladder perfusion of HCPT combined with low-dose BCG (HCPT group), and 85 cases received alternating bladder perfusion of GEM combined with low-dose BCG (GEM group). The follow-up period was 24 months. The tumor recurrence rate, progression rate, time to recurrence and adverse reactions of therapy were observed and recorded, and the risk factors for tumor recurrence were analyzed. Results: The general clinical features of the two groups of patients were comparable, and no patients died during the follow-up period. The 2-year tumor recurrence rate was 18.75% (15/80) in the HCPT group and 13.58% (11/81) in the GEM group, and the tumor progression rate was 5% (4/80) in the HCPT group and 1.23% (1/80) in the GEM group, without statistical significance (p>0.05). The log-rank test showed no statistically significant difference between the two groups in the 2-year survival without recurrence (p>0.05). The progression rate of bladder cancer was 2.5% in the HCPT group and 1.7 % in the GEM group, with no statistically significant difference (p>0.05). Multivariate logistic regression analysis showed that TNM stage, tumor size and tumor pathological grade were independent risk factors for tumor recurrence (p=0.0021, p=0.032, p<0.001, respectively). No significant differences were found in the incidence rates of adverse reactions such as dysuria, fever, rash and gastrointestinal reactions between the two groups, but patients in the HCPT group were more likely to have bladder irritation symptoms and hematuria (p=0.046, p=0.037, respectively). Conclusions: For NMIBC patients after TURBT, alternating bladder perfusion chemotherapies of HCPT and GEM combined with low-dose tuberculin have equal efficacy. The incidence rates of bladder irritation and hematuria symptoms in the GEM group were lower than those in the HCPT group, and the overall tolerance was better in the former, so GEM can be considered as an ideal bladder perfusion chemotherapy drug.