Cancer Res Treat.  2024 Jul;56(3):877-884. 10.4143/crt.2023.1219.

Single Early Intravesical Instillation of Epirubicin for Preventing Bladder Recurrence after Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma

• Lee JH
• Lee CU
• Chung JH
• Song W
• Kang M
• Jeon HG
• Jeong BC
• Seo SI
• Jeon SS
• Sung HH

• KMID: 2557674
• DOI: http://doi.org/10.4143/crt.2023.1219

Abstract

Purpose
We aimed to assess the effectiveness of early single intravesical administration of epirubicin in preventing intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma.
Materials and Methods
Patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy between November 2018 and May 2022 were retrospectively reviewed. Intravesical epirubicin was administered within 48 hours if no evidence of leakage was observed. Epirubicin (50 mg) in 50 mL normal saline solution was introduced into the bladder via a catheter and maintained for 60 minutes. The severity of adverse events was graded using the Clavien-Dindo classification. We compared intravesical recurrence rate between the two groups. Multivariate analyses were performed to identify the independent predictors of bladder recurrence following radical nephroureterectomy.
Results
Epirubicin (n=55) and control (n=116) groups were included in the analysis. No grade 1 or higher bladder symptoms have been reported. A statistically significant difference in the intravesical recurrence rate was observed between the two groups (11.8% at 1 year in the epirubicin group vs. 28.4% at 1 year in the control group; log-rank p=0.039). In multivariate analysis, epirubicin instillation (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.20 to 0.93; p=0.033) and adjuvant chemotherapy (HR, 0.29; 95% CI, 0.13 to 0.65; p=0.003) were independently predictive of a reduced incidence of bladder recurrence.
Conclusion
This retrospective review revealed that a single immediate intravesical instillation of epirubicin is safe and can reduce the incidence of intravesical recurrence after radical nephroureterectomy. However, further prospective trials are required to confirm these findings.

Keyword

Urologic neoplasms; Urothelium; Nephroureterectomy; Intravesical administration; Local neoplasm recurrence

Figure

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  Fig. 1. Participants flow diagram. EPI, epirubicin; RNU, radical nephroureterectomy; UUTUC, upper urinary tract urothelial carcinoma.

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  Fig. 2. Intravesical recurrence-free survival rates after nephroureterectomy. (A) Overall cohorts. (B) Epirubicin (EPI) group vs. Control group.

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  Fig. 3. Progression-free survival rates after nephroureterectomy. (A) Overall cohorts. (B) Epirubicin (EPI) group vs. Control group.

Reference

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