الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Bladder cancer (BC) is one of the most common malignancies, about 75% of BC is non-muscle invasive (NMIBC). The classic treatment of NMIBC is transurethral resection (TURBT) and intravesical bacillus Calmette-Guerin (BCG) immunotherapy. Nevertheless, about 50% of patients with NMIBC experience tumor recurrence and/ or stage or grade progression. Some authors used combination of intravesical chemotherapy in addition to BCG and others used a combination of intravesical BCG with interferon alpha to enhance the therapeutic effects of BCG. Nevertheless, this approach has not gained popularity.Aim of the work: To investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcome of patients with non-muscle invasive bladder cancer (NMIBC) treated by adjuvant intravesical bacillus Calmette-Guérin (BCG) immunotherapy.Patients and Methods: In a propensity clinical study, 100 patients with primary NMIBC who received intradermal PPD 2 weeks before adjuvant BCG therapy in a prospective manner were included and another matched 100 patients with primary NMIBC not given PPD before BCG therapy were chosen as a control. PPD skin test reactions were categorized into positive and negative reactions. Urine and blood samples were collected to detect the levels of TNFα and IL6. Oncological outcomes, immunological markers changes and the rate of BCG side effects were statistically evaluated. Results: There were no significant differences between patients who received PPD or not regarding the 2-year recurrence and progression-free survival rates, immunological markers changes and BCG side effects. The 2-year recurrence-free survival rates of patients with a positive and negative PPD skin test reactions were 89.5% and 72% respectively with a significant difference (P=0.02). The 2-year progression-free survival rates were higher in patients with a positive reactions with a significant difference (P=0.038). Post induction values of immunological markers (TNFα and IL-6) increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions.Conclusion: The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes, immunological markers and BCG side effects of patients with NMIBC treated with TURBT and adjuvant intravesical BCG. However the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.Recommendations: PPD skin test reactions before BCG therapy can be used for prediction of the oncological outcomes of patients with NMIBC treated with TURBT and adjuvant BCG.