Recurrence of superficial bladder cancers after in-travesical chemotherapy with doxorubicin

Abstract

Introduction: Bladder cancer is a highly prevalent disease; its most significant problem is its tendency to recur and progress. To reduce this recurrence and progression as much as possible, many intravesical chemotherapeutics applied over months after transurethral resection of the bladder have been used with mixed results. Doxorubicin is an anthracycline antibiotic with antitumor activity produced by Streptococcus peucetius var. cesius. It can intercalate with DNA, affects many of its functions, and inhibits the synthesis of DNA and RNA, which acts intravesically to prevent the implantation of circulating tumor cells.

Methodology: The study will be of an observational, descriptive, retrospective, cross-sectional type between January 1, 2018, and January 31, 2021, and developed in the Urology Service of the Teodoro Maldonado Carbo Hospital.

Results: A total of 148 cases were analyzed. The specificity of the index was 81%, with a positive predictive value (PV) of 77% and a negative PV of 68%. The sensitivity of ascites was 85%, and that of the palpable abdominal mass was 79%. In patients who presented CA-125 antigen values less than 1000 U/ml, the risk of obtaining optimal cytoreduction was OR: 0.15 (95% CI 0.069 - 0.307; P: 0.0001). The patients who presented unresectability index values between 1 and 2 points versus 3 and 4 points were OR: 7.04 (95% CI 3.33 -14.87, P: 0.0001).

Conclusions: Bladder cancer is a prevalent disease that presents significant challenges due to its propensity for recurrence and progression. To address this problem, various intravesical chemotherapeutics have been used after transurethral resection of the bladder, although with variable results. Doxorubicin, an anthracycline antibiotic with antitumor properties, has demonstrated the ability to interfere with DNA and RNA, making it a valuable option to prevent the implantation of circulating tumor cells when administered intravesically.