An immediate, single intravesical instillation of mitomycin C is of benefit in patients with non–muscle-invasive bladder cancer irrespective of prognostic risk groups

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Abstract

Background: In a recent meta-analysis, subgroups of patients were defined that may not benefit from a single, immediate instillation with chemotherapy. This led to a change in the European Association of Urology bladder cancer guidelines. In a previous paper, our group confirmed the efficacy of an immediate instillation of mitomycin C (MMC). However, prognostic groups in that study differ from those in the meta-analysis. Therefore, we performed a reanalysis using contemporary risk groups. Objectives: To validate whether specific subgroups of patients with non–muscle-invasive bladder cancer (NMIBC) benefit from an immediate instillation with MMC. Patients and methods: All 2,243 NMIBC patients enrolled in our randomized controlled trial between 1998 and 2003 were analyzed. Treatment effect was investigated for all subgroups, including subgroups that did not benefit from an immediate instillation according to the meta-analysis. Time to recurrence was assessed using Kaplan-Meier curves and multivariable Cox regression. Differences in treatment effect between subgroups was tested using the variable treatment by covariate interactions in a Cox regression model. Results: The difference in time to recurrence was statistically significant in favor of an immediate instillation with MMC (P < 0.001) which corresponds to a 25% risk reduction (hazard ratio: 0.75, 95% confidence interval, 0.64–0.88, P < 0.001). Treatment effect of an immediate instillation with MMC did not differ significantly between any of the subgroups. Conclusions: In contrast to the recommendations in the European Association of Urology guidelines, we could not identify any subgroup of patients with NMIBC who do not benefit from an immediate instillation with MMC after transurethral resection.

Original languageEnglish
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
Publication statusAccepted/In press - 1 Jan 2018

Cite this

@article{a2506a85c3a44a928d79366a26622c6f,
title = "An immediate, single intravesical instillation of mitomycin C is of benefit in patients with non–muscle-invasive bladder cancer irrespective of prognostic risk groups",
abstract = "Background: In a recent meta-analysis, subgroups of patients were defined that may not benefit from a single, immediate instillation with chemotherapy. This led to a change in the European Association of Urology bladder cancer guidelines. In a previous paper, our group confirmed the efficacy of an immediate instillation of mitomycin C (MMC). However, prognostic groups in that study differ from those in the meta-analysis. Therefore, we performed a reanalysis using contemporary risk groups. Objectives: To validate whether specific subgroups of patients with non–muscle-invasive bladder cancer (NMIBC) benefit from an immediate instillation with MMC. Patients and methods: All 2,243 NMIBC patients enrolled in our randomized controlled trial between 1998 and 2003 were analyzed. Treatment effect was investigated for all subgroups, including subgroups that did not benefit from an immediate instillation according to the meta-analysis. Time to recurrence was assessed using Kaplan-Meier curves and multivariable Cox regression. Differences in treatment effect between subgroups was tested using the variable treatment by covariate interactions in a Cox regression model. Results: The difference in time to recurrence was statistically significant in favor of an immediate instillation with MMC (P < 0.001) which corresponds to a 25{\%} risk reduction (hazard ratio: 0.75, 95{\%} confidence interval, 0.64–0.88, P < 0.001). Treatment effect of an immediate instillation with MMC did not differ significantly between any of the subgroups. Conclusions: In contrast to the recommendations in the European Association of Urology guidelines, we could not identify any subgroup of patients with NMIBC who do not benefit from an immediate instillation with MMC after transurethral resection.",
keywords = "Bladder cancer, Bladder neoplasms: mitomycin C, Intravesical chemotherapy, Non–muscle-invasive urothelial carcinoma",
author = "Judith Bosschieter and Nieuwenhuijzen, {Jakko A.} and Vis, {Andr{\'e} N.} and {van Ginkel}, Tessa and Lissenberg-Witte, {Birgit I.} and Beckers, {Goedele M.A.} and {van Moorselaar}, {R. Jeroen A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2018.05.026",
language = "English",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - An immediate, single intravesical instillation of mitomycin C is of benefit in patients with non–muscle-invasive bladder cancer irrespective of prognostic risk groups

AU - Bosschieter, Judith

AU - Nieuwenhuijzen, Jakko A.

AU - Vis, André N.

AU - van Ginkel, Tessa

AU - Lissenberg-Witte, Birgit I.

AU - Beckers, Goedele M.A.

AU - van Moorselaar, R. Jeroen A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: In a recent meta-analysis, subgroups of patients were defined that may not benefit from a single, immediate instillation with chemotherapy. This led to a change in the European Association of Urology bladder cancer guidelines. In a previous paper, our group confirmed the efficacy of an immediate instillation of mitomycin C (MMC). However, prognostic groups in that study differ from those in the meta-analysis. Therefore, we performed a reanalysis using contemporary risk groups. Objectives: To validate whether specific subgroups of patients with non–muscle-invasive bladder cancer (NMIBC) benefit from an immediate instillation with MMC. Patients and methods: All 2,243 NMIBC patients enrolled in our randomized controlled trial between 1998 and 2003 were analyzed. Treatment effect was investigated for all subgroups, including subgroups that did not benefit from an immediate instillation according to the meta-analysis. Time to recurrence was assessed using Kaplan-Meier curves and multivariable Cox regression. Differences in treatment effect between subgroups was tested using the variable treatment by covariate interactions in a Cox regression model. Results: The difference in time to recurrence was statistically significant in favor of an immediate instillation with MMC (P < 0.001) which corresponds to a 25% risk reduction (hazard ratio: 0.75, 95% confidence interval, 0.64–0.88, P < 0.001). Treatment effect of an immediate instillation with MMC did not differ significantly between any of the subgroups. Conclusions: In contrast to the recommendations in the European Association of Urology guidelines, we could not identify any subgroup of patients with NMIBC who do not benefit from an immediate instillation with MMC after transurethral resection.

AB - Background: In a recent meta-analysis, subgroups of patients were defined that may not benefit from a single, immediate instillation with chemotherapy. This led to a change in the European Association of Urology bladder cancer guidelines. In a previous paper, our group confirmed the efficacy of an immediate instillation of mitomycin C (MMC). However, prognostic groups in that study differ from those in the meta-analysis. Therefore, we performed a reanalysis using contemporary risk groups. Objectives: To validate whether specific subgroups of patients with non–muscle-invasive bladder cancer (NMIBC) benefit from an immediate instillation with MMC. Patients and methods: All 2,243 NMIBC patients enrolled in our randomized controlled trial between 1998 and 2003 were analyzed. Treatment effect was investigated for all subgroups, including subgroups that did not benefit from an immediate instillation according to the meta-analysis. Time to recurrence was assessed using Kaplan-Meier curves and multivariable Cox regression. Differences in treatment effect between subgroups was tested using the variable treatment by covariate interactions in a Cox regression model. Results: The difference in time to recurrence was statistically significant in favor of an immediate instillation with MMC (P < 0.001) which corresponds to a 25% risk reduction (hazard ratio: 0.75, 95% confidence interval, 0.64–0.88, P < 0.001). Treatment effect of an immediate instillation with MMC did not differ significantly between any of the subgroups. Conclusions: In contrast to the recommendations in the European Association of Urology guidelines, we could not identify any subgroup of patients with NMIBC who do not benefit from an immediate instillation with MMC after transurethral resection.

KW - Bladder cancer

KW - Bladder neoplasms: mitomycin C

KW - Intravesical chemotherapy

KW - Non–muscle-invasive urothelial carcinoma

UR - http://www.scopus.com/inward/record.url?scp=85050632259&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2018.05.026

DO - 10.1016/j.urolonc.2018.05.026

M3 - Article

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

ER -