Point. Routine use of postoperative intravesical chemotherapy after TURBT-should it be done?

摘要

At diagnosis, most bladder cancers (BC) are confined to the mucosa (Ta) or lamina propria (T1). Ta, T1, and carcinoma in situ (CIS) are commonly grouped together as nonmuscle- invasive bladder cancer (NMIBC), which is unfortunate because this is a heterogeneous set of tumors with vastly different prognoses. We prefer to use the tumor grade and stage when discussing a patient with bladder tumors, eg, low-grade Ta, high-grade T1. In an attempt to deal with this heterogeneity, some groups have stratified NMIBC into 3 risk categories based on several prognostic factors including stage, grade, number of tumors, and the presence of CIS. EORTC risk tables demonstrate 5-year recurrence rates of 31% for those at low risk, 62% for intermediate risk, and 78% for high risk. The aim of early postoperative adjuvant intra-vesical chemotherapy is to reduce the recurrence rate of Ta and T1 BC. CIS is unlikely to be dramatically affected by postoperative intravesical chemotherapy and there are minimal data on its response.