Adjuvant Intravesical Chemotherapy Versus Immunotherapy for All Risk Groups of Patients With Non-muscle Invasive Bladder Cancer.

Background: The treatment strategy for non-muscle invasive bladder cancer (NMIBC) has not changed significantly over the past 30 years. Chemotherapeutic agents (mitomycin-C, epirubicin, etc.) and BCG (Bacillus Calmette-Guerin) immunotherapy are used as adjuvant intravesical therapy. Objective: To compare the difference between adjuvant chemotherapy and adjuvant immunotherapy in their efficacy of reducing the number of tumor recurrences. Methods: In this prospective clinical study, which included 99 patients with NMIBC from March 2018.-March 2023., we publish the results for all risk groups of patients treated with intravesical chemotherapy Epirubicin or with BCG immunotherapy, after TURBT (Trans urethral resection of bladder tumor) within 1 year. Patients were stratified into 2 groups. The first group was treated with Epirubicin (1 dose within 24 hours of surgery, then 6 weekly instillations and 3 maintenance doses), and the second group was treated with BCG (2-3 weeks after TURBT 6 weekly instillations, and 3 maintenance doses). The monitoring period was 24 months. Results: In patients treated with intravesical chemotherapy, recurrence occurred in 9 patients (17.64%), and in patients treated with BCG, recurrence occurred in 7 patients (14.58%). A similar incidence of disease recurrence was observed in both groups (p=0.787). Conclusion: The results of our study show a similar therapeutic response by risk groups of patients treated with chemotherapy and immunotherapy. Since BCG production will cease in the future, the task of urologists is to introduce intravesical chemotherapy into wider use and to modernize it as a safe and effective method of adjuvant treatment for non-muscle-invasive bladder cancer.

One hundred kidney transplantations in Tuzla.

INTRODUCTION: Kidney transplantation assures considerably better quality of life than the treatment of end-stage renal disease patients with dialysis. GOAL: Authors intended to present results of kidney transplantations that were performed for over 13 years in UCC Tuzla. EXAMINEES AND METHODS: Total of 100 transplantations have been done over 13 years. The gender and age structure have been presented, as well as number of transplantations per year, type of transplantation (living related donor, living unrelated donor, deceased donor), number and percentage of donors and results of transplantations expressed as survival of both the patient and transplanted kidney/ renal graft. We also wanted to presented other important events such as dates of introduction of certain drugs, dates of first cadaver transplantation, transplantation with desensitization protocols and dates of first living unrelated (spousal/emotional) transplantation. RESULTS: The survival of patients and renal grafts were demonstrated by Kaplan-Meier curve, and obtained results were fully in range of results recommended in other literature and by other authors. One-year survival of graft is 94%, with five-year survival being 75%. One-year survival of patients is 95%, and five-year survival of patients was 84%. DISCUSSION: Our results have been compared to those from other studies, gaining suggestions for transplantation improvement. CONCLUSION: Among all modifications of renal replacement therapy transplantation is by far the method of choice because, its well known advantages aside, it also has an economical advantage over chronic treatment with dialysis and it should therefore become interesting to healthcare systems.

Predicting recurrence of non-muscle-invasive bladder cancer after transurethral resection.

AIM: To determine clinical prognostic factors and their impact on the risk of recurrence of newly discovered non-muscle-invasive bladder cancer. METHODS: The study included 120 patients of both sexes aged 45-80 years with newly discovered non-muscle-invasive bladder cancer. All the patients were treated surgically by transurethral electro resection (TUER). The outcome of patients with and without recurrence was followed at intervals of three months after surgery, the total of two years. For monitoring the probability of early recurrence the criteria of the European Organization for Research and Treatment of Cancer (EORTC) were used. RESULTS: The average age of the patients was 65.9 years, 79 (79.2%) males and 21 (20.8%) females. The total of 67 (55.8%) patients had a recurrence during the period of monitoring. The average time to the first and fourth recurrence was 15.4 and 23.9 months, respectively. Numbers of tumors and a degree of invasion had a significant prognostic impact on the risk of recurrence. The EORTC score was a highly significant predictor of recurrence (OR=1.237; p < 0.001). CONCLUSION: Based on available clinical and pathological prognostic factors and by stratification of patients into three disease risk groups it is possible to predict the possibility of disease. Individual approach and recommendations for the treatment using EORTC risk tables should improve the quality of treatment.

Clinical importance of independent prognostic factors for renal parenchymal carcinoma and a possibility of predicting the treatment outcome.

AIM: To determine the influence of independent predictors (nuclear grade, patient's general condition, tumor size) on survival of patients suffering from renal cancer. METHODS: The study included 158 patients treated for renal parenchymal carcinoma in the period between 01. 01. 1998 and 31. 12. 2011. The patients' general condition was evaluated using the ECOG staging system. Nuclear grade (NG) was assessed by the Fuhrman criteria. Prognostic factors were tested applying the Cox regression analysis and based on the significance independent predictors were determined. RESULTS: The total survival rate of patients with renal parenchymal carcinoma was 81.2% after one year, 77.6% after 5 years and 70.4% after 10 years. In patients with NG 1 the survival rate after 5 years was 100%, whereas the survival in patients with NG2, 3 and 4 was 98%, 48% and 0%, respectively. The survival rate in patients with ECOG 0 and 1 after 5 years was 100%, while in patients with ECOG 2 and 3 stage of the disease the survival rate was 68% and 25%, respectively. In patients with a tumor node less than 40 mm, ten-year survival rate was100%, whereas the ten-year survival rate in patients with the tumor node sized 40 to 70 mm was 87%, and in patients with the tumor node over 70 mm ten-year survival rate was 66%. CONCLUSION: Multivariate analysis has established that the size of the tumor node, patient's general condition and nuclear grade are independent predictors of disease outcome.

Clinical importance of dependent prognostic factors for renal parenchymal carcinoma and a possibility of predicting the treatment outcome.

AIM: To determine an influence of dependent predictors (clinical presentation, stage, pH type) on survival of patients suffering from renal carcinoma. METHODS: The research included 158 patients who had been treated for carcinoma of renal parenchyma in the period between 1 January 1998 and 31 December 2011. A disease stage was determined according to the guidelines of the American Joint Committee on Cancer (AJCC). Prognostic factors were tested by the Cox regression analysis, and dependent prognostic factors were determined based on significance. RESULTS: Patient survival was significantly different in relation to the clinical presentation of the disease (p less than 0.0001). Length of patient survival significantly differs with regard to the clinical stage of the disease (p less than 0.0001). The length of patient survival significantly differs depending on a pathohistological type of cancer (p=0.0027) and after five years it was much longer for patients with the conventional cancer type as compared with the chromophobe type, 80.3% vs. 61.5%, respectively. The total survival rate of patients with renal parenchymal cancer is 81.2% after one year, 77.6% after 5 years and 70.4% after 10 years. CONCLUSION: The manner of detection, clinical stage and pathohistological type of the disease did not meet requirements for independent predictors. Success of the therapeutic treatment depends on the manner of the renal cell carcinoma presentation, pathohistological type and tumor stage.

Influence of surgical complications on graft and patients' survival after a kidney transplantation according to donors' age.

The aim of this study was to determine a frequency and a type of early and late surgical complications in kidney transplantation, their impact on renal graft survival among 80 patients, 54 (67.5%) males and 26 (32.5%) females who had undergone a living and cadaveric kidney transplant at the Surgery Center in Tuzla in the period from 15.09.1999 until 31.12.2008. The subjects were divided into two groups according to donor age, younger and older than 55. A significantly higher incidence of early rather than late surgical complications was observed in an experimental group (p=0.001, and p=0.77, respectively). There was a statistically significant difference in the length of graft survival (p=0.004) and the number of deaths (p=0.038). Older age of kidney graft donor had an impact on the occurrence of early surgical complications and no influence on the occurrence of late surgical complications. Fatal outcome after kidney transplantation was significantly higher in patients who received grafts of elderly people.