Analysis of prognostic factors related to primary superficial bladder cancer tumor recurrence in prophylactic intravesical epirubicin therapy

Purpose: The aims of the present study were to examine the effects of intra vesical instillation of epirubicin on tumor recurrence and to identify tumo rs that are at a high risk of recurrence. Methods: Forty-five patients with primary superficial bladder cancer were t reated with prophylactic intravesical epirubicin following transurethral re section of the bladder tumor (TUR-BT). Epirubicin (20 mg) was administered intravesically every second week for 4 months and then once a month or ever y 2 weeks for next 8 months. Patients were analyzed with respect to prognos tic factors related to tumor recurrence. Results: The overall recurrence-free rate, calculated using the Kaplan-Meie r method, was 76.1 and 52.3% at 2 and 5 years after operation, respectively . These results were better than those reported for patients treated with T UR-BT alone. A univariate analysis demonstrated that high-grade, TI, sessil e, large (greater than or equal to 2cm) and multiple tumors were a signific antly high risk for recurrence. A multivariate analysis performed by using the Cox proportional hazard model with stepwise selection showed that morph ologic features (pedunculated or sessile) were the most prognostic factors for recurrence. This was followed by age and tumor size. The remaining four factors were not found to contribute significantly to recurrence. Conclusions: Epirubicin appears to be effective in preventing the recurrenc e of superficial bladder cancer. Morphologic features, patient age and size of the turner were considered independent risk factors. The risk of recurr ence for each tumor should be taken into consideration when the intravesica l adjuvant therapy protocol is being selected.