Husakovskyi S. Prognosis factors and choice of adjuvant chemotherapy for non-muscle invasive bladder cancer

ANNOTATION The work was performed during the period from 2018 to 2021. Clinical material was presented to 161 patients who underwent transurethral resection (TUR) of the bladder tumor and performed intravesical instillation of chemotherapeutics. The diagnoses of all patients were verified according to the histopathological conclusion. The study was designed to analyze retrospective and prospective data from patients with non-invasive bladder cancer. The retrospective analysis consisted of comparing the results of the effectiveness of treatment of patients who underwent intravesical instillation of the chemotherapeutic agent with patients who did not undergo intravesical instillation. Prospective analysis included a comparison of efficacy between intravesical instillations of chemotherapeutics and instillations of chemotherapeutics with Dimethyl sulfoxide. Also, prognostic factors were selected in all patients and the most significant ones were determined by statistical analysis. The study included patients with low- and medium-risk non-invasive bladder cancer, which were divided into 4 groups depending on the treatment received. The first group (n = 47) was created from patients with NMIBC who underwent intravesical instillation with Doxorubicin after TUR. The second group (n = 42) consisted of patients who were instilled with Epirubicin after TUR. The third group (n = 35) included patients who underwent intravesical instillation of Epirubicin in combination with Dimethyl sulfoxide after TUR. The fourth group (n = 37) was a control group, patients of this group after TUR did not receive any intravesical instillation. According to the study design, 6 pairwise group comparisons were performed. The scientific novelty of the study is that it identified the most significant prognostic factors - age, previous recurrence, number of tumors, tumor basis, recurrence in the first 6 months, category T, class G, tumor diameter, erythrocyturia, leg diameter, number of instillations. It is proved for the first time that the number of prognostic factors increases with the increase of the observation period. It was found that prognostic factors may vary depending on the method of treatment. It was stated that the number of intravesical instillations does not affect the progression of the disease. The efficacy of different adjuvant intravesical chemotherapy regimens was compared. A new regimen of adjuvant intravesical chemotherapy has been proposed. The analysis of the proposed algorithm of intravesical chemotherapy has been carried out. Adjuvant intravesical chemotherapy with Epirubicin instillations in combination with Dimethyl sulfoxide has been shown to be more effective than intravesical instillation of Doxorubicin, Epirubicin, or TUR without intravesical instillation.