Defining the optimal duration of maintenance mitomycin C in intermediate-risk Ta NMIBC: a multicenter retrospective landmark analysis.
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Contieri Roberto, Jannello Letizia Maria Ippolita, Vartolomei Mihai Dorin, Roth Beat, Bianchi Roberto, Fallara Giuseppe, Tozzi Marco, Maggi Martina, Chierigo Francesco, Pellegrino Francesco, Cella Ludovica, Uleri Alessandro, Da Pozzo Luigi, Claps Francesco, Aveta Achille, Spena Gianluca, Checcucci Enrico, Gatti Cecilia, Bove Pierluigi, Vedovo Francesca, Busetto Gian Maria, Falagario Ugo, Mastroianni Riccardo, Tedde Alessandro, Madonia Massimo, Di Tonno Pasquale, Lucarelli Giuseppe, Forte Saverio, Russo Giorgio Ivan, Verweij Fabrizio, Racioppi Marco, Bizzarri Francesco Pio, Borghesi Marco, Rinaldi Marco, Zattoni Fabio, Boeri Luca, De Lorenzis Elisa, Conti Andrea, Cerruto Maria Angela, Crocetto Felice, Simone Giuseppe, Di Stasi Savino Mauro, De Nunzio Cosimo, Carmignani Luca, Liguori Giovanni, Porreca Angelo, Barone Biagio, Montanari Emanuele, Giancarlo Albo, Antonelli Alessandro, Veccia Alessandro, Moro Fabrizio Dal, Carrieri Giuseppe, Cormio Luigi, Terrone Carlo, Porpiglia Francesco, Perdonà Sisto, Rocco Bernardo, Hurle Rodolfo, Catellani Michele, Ferro Matteo
Аннотация
METHODS: We conducted a retrospective multicenter analysis of patients with Ta NMIBC treated with transurethral resection and adjuvant MMC across 13 Italian centers (2010-2023). Patients were grouped based on MMC maintenance duration: no maintenance, short-term (≤ 6 instillations), and long-term (> 6 instillations). Kaplan-Meier curves, Cox regression, and CART analysis were used to evaluate RFS and high-grade RFS (HG-RFS).
RESULTS: Among 292 patients included, maintenance therapy significantly improved 2-year and 3-year RFS compared to no maintenance (78% vs. 55% and 67% vs. 30%, respectively; p < 0.001). CART analysis identified > 6 instillations as the threshold for optimal benefit. Long-term maintenance was associated with a lower risk of recurrence (HR 0.23 vs. no maintenance; HR 0.39 vs. short-term; both p < 0.001). No significant difference in HG-RFS was observed between no maintenance, long-term, and short-term groups.
CONCLUSION: Long-term MMC maintenance (> 6 instillations) significantly prolongs RFS in patients with Ta NMIBC. These findings suggest that extended MMC regimens may improve patients' outcomes and should be considered in clinical practice. Prospective studies are needed to confirm these results and guide evidence-based treatment strategies.