肌层浸润性膀胱癌保留膀胱综合治疗的疗效评价研究

摘要

Objective To investigate the clinical efficacy of the comprehensive therapy consisting of iliac artery infu-sion chemotherapy, transurethral resection of bladder tumor (TUR-BT) and bladder perfusion chemotherapy for muscle-invasive bladder cancer. Method Patients with muscle-invasive bladder cancer (stage T2N0M0) were divided into two groups according to the treatment they had used , with 64 cases treated by iliac artery infusion chemotherapy (Pirarubicin 40 mg/m2, 5-FU 1000 mg/m2, hydroxyamptothecin 30 mg/m2), TUR-BT and bladder perfusion chemotherapy into compre-hensive therapy group, 62 cases treated by TUR-BT and bladder perfusion chemotherapy into control group, and the tu-mor recurrence/metastasis, mortality and treatment-related adverse reactions after treatment were compared between two groups. Result As of the end of follow-up, 93.75%(60/64) of the patients in the comprehensive therapy group showed neither recurrence nor metastasis, higher than 45.16% (28/62) in the control group, with statistically significant inter-group differences observed (P=0). 3.13% (2/64) of the patients in the comprehensive therapy group died of metastasis, significantly lower than 16.13%(10/62) in the control group (P=0.015). The non-bladder cancer mortality was 10.94%(7/64) vs 12.90%(8/62) in comprehensive therapy group vs control group, with no significant difference observed (P>0.05). Conclusion The comprehensive therapy consisting of iliac artery infusion chemotherapy, TUR-BT and bladder perfu-sion chemotherapy can reduce tumor recurrence and mortality in patients with muscle-invasive bladder cancer (T2N0M0), without risk of increasing non-cancer death, so it's a regimen worth further investigation.%目的 评价髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗综合治疗肌层浸润性膀胱癌的临床疗效.方法 比较64例采用髂内动脉灌注化疗(吡柔比星40 mg/m2、5-FU 1000 mg/m2、羟喜树碱30 mg/m2)+经尿道膀胱肿瘤电切术+膀胱内灌注化疗(综合治疗组)和62例采用经尿道膀胱肿瘤电切术+膀胱内灌注化疗(对照组)的肌层浸润性膀胱癌(T2N0M0期)患者经治疗后的肿瘤复发/转移率、死亡率及治疗相关不良反应的发生情况.结果 至随访截至日期,综合治疗组的无复发/转移率为93.75%(60/64),明显高于对照组的45.16%(28/62),差异有统计学意义(P=0);转移死亡率为3.13%(2/64),低于对照组的16.13%(10/62),差异有统计学意义(P=0.015);非膀胱癌死亡率为10.94%(7/64),与对照组的12.90%(8/62)相比,差异无统计学意义(P﹥0.05).结论 髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗的综合治疗方案,能够降低肌层浸润性膀胱癌(T2N0M0)患者肿瘤复发率和死亡率,不增加非癌性死亡风险,值得进一步探讨.