膀胱癌根治术前单次动脉灌注化疗的长期疗效评估

摘要

目的 评估腹腔镜膀胱癌根治(laparoscopic radical cystectomy,LRC)术前单次新辅助动脉灌注化学药物治疗(以下简称化疗)对长期预后的影响.方法 回顾性分析2006年2月至2015年12月间于首都医科大学附属北京朝阳医院行LRC术前26例单次动脉灌注化疗的患者围术期临床资料和随访结果.结果 26例患者LRC术前2 ～4周内行动脉灌注化疗,其中回肠膀胱9例,原位回肠新膀胱15例,输尿管皮肤造口2例,无中转开放.平均手术时间373 min(210～600 min),平均术中出血量为407 mL( 100～1 400 mL).术后病理提示均为尿路上皮癌,6例低级别,20例高级别,切缘均未见肿瘤.7例临床分期与病理分期相符,降期17例,升期2例,与术前临床分期相比,单次动脉灌注化疗局部降期效果显著(P=0.002).平均淋巴结清扫数目17个(8 ～28个),8例淋巴结阳性.术后30 d内的合并症发生率在低级别和高级别肿瘤之间差异无统计学意义(P =0.081).术后30 d内,30至90 d内以及超过90 d Clavien 3级以上合并症分别为3例、1例和2例.平均随访时间88个月(2～121个月),肿瘤特异性死亡2例,其他原因死亡1例,其中低级别和高级别肿瘤之间的总生存率(P = 0.746)和肿瘤特异性生存率(P=0.446)差异均无统计学意义.结论 LRC术前进行单侧动脉灌注化疗并没有明显增加术后合并症,且同时起到显著地降期降级作用,但在肿瘤学预后方面还需要随机对照研究进行评估.%Objective Evaluation of long-term outcome of one-shot intra-arterial chemotherapy as new adjuvant therapy before laparoscopic radical cystectomy(LRC). Methods We retrospectively analyzed the preoperative clinical data and follow-up results of 26 patients who received one-shot intra-arterial chemotherapy before LRC in Urology Department of Beijing Chaoyang Hospital from February 2006 to December 2015. Results All patients were performed one-shot intra-arterial chemotherapy 2-4 weeks before the LRC and completed laparoscopic procedure without open conversion (ileal conduit urinary diversion for 9 patients, orthotopic ileal neobladder for 15 patients and cutaneous ureterostomy for 2 patients). The average operation time was 373 min (210-600 min) with estimated blood loss of 407 mL (100-1 400 mL). All pathology was urothelial cell carcinoma of the urinary bladder with 6 low grade and 20 high grade. No positive surgical margins were reported. Compared with clinical TNM stages, pathological TNM stages demonstrated significant decrease (P = 0.002): 7 cases had no changed, 17 cases achieved a stage decrease, and 2 cases had risen. The average lymph node number was 17 (8-28) including 8 positive cases. There was no statistical difference in 30-day postoperative complications between the low grade and high grade tumor (= 0.081). The number of Clavien level 3 or higher complications within 30 day, 30 to 90 days, and more than 90 days were 3 cases, 1 case and 2 cases, respectively. The patients were followed up for 88 months (2-121 months). There were two cancer-specific deaths and one died of other causes during the follow-up period; however, no difference was found in terms of overall survival (P = 0.746) and cancer specific survival (P = 0.446) between the low grade and high grade tumor. Conclusion With long-term follow-up, one-shot intra-arterial chemotherapy did not significantly increase the post-operative complications, at the same time significantly decreased the pathological stage and grade. Randomized trials will be required to better assess the oncology outcome.