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A novel view on the pathogenesis of complications after intravesical BCG for bladder cancer

机译：膀胱癌膀胱内卡介苗术后并发症发病机制的新观点

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Intravesical bacillus Calmette-Guérin (BCG) is widely used for high-risk, non-muscle-invasive bladder cancer. This report describes four cases that illustrate the spectrum of BCG-induced complications, varying from granulomatous prostatitis to sepsis. There is considerable debate regarding whether inflammation or infection is the predominant mechanism in the pathogenesis of BCG disease. In two patients with a systemic illness, the symptoms first resolved after adding prednisone, indicating a principal role for inflammation in systemic disease. In vitro testing of T-cell responses and a mycobacterial growth inhibition assay were performed for these patients with systemic disease. The patient with mild symptoms showed more effective in vitro growth reduction of BCG, while the patient with sepsis and organ involvement had high T-cell responses but ineffective killing. While these findings are preliminary, it is believed that immunological assays, as described in this report, may provide a better insight into the pathogenesis of BCG disease in individual patients, justifying further research.
机译：膀胱内卡介苗（BCG）被广泛用于高风险，非肌肉浸润性膀胱癌。该报告描述了四例病例，这些病例说明了BCG引起的并发症的范围，从肉芽肿性前列腺炎到败血症不等。关于炎症或感染是BCG疾病发病机理的主要机制，存在许多争论。在两名患有全身性疾病的患者中，在加入泼尼松后症状首先得到缓解，表明炎症是全身性疾病的主要作用。对这些患有系统性疾病的患者进行了T细胞反应的体外测试和分枝杆菌生长抑制测定。症状较轻的患者表现出更有效的降低BCG的体外生长，而脓毒症和器官受累的患者具有较高的T细胞反应，但杀伤效果不佳。尽管这些发现是初步的，但可以相信，如本报告所述，免疫学检测可以更好地了解个别患者中BCG的发病机理，因此有待进一步研究。

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