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Purpose <p>While mitomycin C (MMC) is widely used for intravesical therapy, the optimal maintenance regimen for non-muscle invasive bladder cancer (NMIBC) remains unclear. This study assessed the impact of MMC maintenance on recurrence-free survival (RFS) in patients with intermediate-risk Ta NMIBC and aimed to identify the optimal number of instillations for improved outcomes.</p> Methods <p>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 (&gt; 6 instillations). Kaplan–Meier curves, Cox regression, and CART analysis were used to evaluate RFS and high-grade RFS (HG-RFS).</p> Results <p>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; <i>p</i> &lt; 0.001). CART analysis identified &gt; 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 <i>p</i> &lt; 0.001). No significant difference in HG-RFS was observed between no maintenance, long-term, and short-term groups.</p> Conclusion <p>Long-term MMC maintenance (&gt; 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.</p>

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Defining the optimal duration of maintenance mitomycin C in intermediate-risk Ta NMIBC: a multicenter retrospective landmark analysis

  • 期刊论文

  • 发表日期：

    2026年1月2日

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  • Roberto Contieri,
  • Letizia Maria Ippolita Jannello,
  • Mihai Dorin Vartolomei,
  • Beat Roth,
  • Roberto Bianchi,
  • Giuseppe Fallara,
  • Marco Tozzi,
  • Martina Maggi,
  • Francesco Chierigo,
  • Francesco Pellegrino,
  • Ludovica Cella,
  • Alessandro Uleri,
  • Luigi Da Pozzo,
  • Francesco Claps,
  • Achille Aveta,
  • Gianluca Spena,
  • Enrico Checcucci,
  • Cecilia Gatti,
  • Pierluigi Bove,
  • Francesca Vedovo,
  • Gian Maria Busetto,
  • Ugo Falagario,
  • Riccardo Mastroianni,
  • Alessandro Tedde,
  • Massimo Madonia,
  • Pasquale Di Tonno,
  • Giuseppe Lucarelli,
  • Saverio Forte,
  • Giorgio Ivan Russo,
  • Fabrizio Verweij,
  • Marco Racioppi,
  • Francesco Pio Bizzarri,
  • Marco Borghesi,
  • Marco Rinaldi,
  • Fabio Zattoni,
  • Luca Boeri,
  • Elisa De Lorenzis,
  • Andrea Conti,
  • Maria Angela Cerruto,
  • Felice Crocetto,
  • Giuseppe Simone,
  • Savino Mauro Di Stasi,
  • Cosimo De Nunzio,
  • Luca Carmignani,
  • Giovanni Liguori,
  • Angelo Porreca,
  • Biagio Barone,
  • Emanuele Montanari,
  • Albo Giancarlo,
  • Alessandro Antonelli,
  • Alessandro Veccia,
  • Fabrizio Dal Moro,
  • Giuseppe Carrieri,
  • Luigi Cormio,
  • Carlo Terrone,
  • Francesco Porpiglia,
  • Sisto Perdonà,
  • Bernardo Rocco,
  • Rodolfo Hurle,
  • Michele Catellani,
  • Matteo Ferro

摘要

Purpose

While mitomycin C (MMC) is widely used for intravesical therapy, the optimal maintenance regimen for non-muscle invasive bladder cancer (NMIBC) remains unclear. This study assessed the impact of MMC maintenance on recurrence-free survival (RFS) in patients with intermediate-risk Ta NMIBC and aimed to identify the optimal number of instillations for improved outcomes.

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.