目的 比较保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌的预后.方法 检索保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的对照研究,比较两种治疗方案的术后5年生存率,计算合并优势比(OR)和95%CI.结果 共纳入7项研究,累积876例患者.1组研究的OR=1.03,95%CI为1.03(0.52~2.02),4组研究的OR及其95%CI﹤1,2组研究的OR及其95%CI﹥1;7个研究的总OR=1.05,95%CI为1.05(0.53~2.06),跨过"无差异线",故认为根治性膀胱全切术(radical cystectomy,RC)与保留膀胱的综合治疗预后差异无统计学意义(Z=0.13,P=0.89).结论 对于部分肌层浸润性膀胱癌患者,保留膀胱的综合治疗不会降低患者的5年生存率,且能保留患者膀胱的正常功能,提高了患者的生存质量,但适应证需严格把握.%Objective To compare the prognosis of bladder preservation surgery+postoperative chemotherapy with that of radical cystectomy in patients with muscle-invasive bladder cancer. Method Controlled trials that compare blad-der preservation surgery+postoperative chemotherapy with radical cystectomy in patients with muscle-invasive bladder cancer were retrieved, with the 5-year postoperative survivals compared and odds ratio (OR) and 95%confidence interval (95%CI) calculated. Result 7 trials (876 patients in total) were included. The meta-analysis results showed that:one tri-al had an OR of 1.03 and a 95%CI of 1.03 (0.52~2.02);in four other trials, the corresponding OR and 95%CI were all<1;OR and 95%CI of the remaining two trials were>1;the total OR of the 7 trials was 1.05, and the 95%CI was 1.05 (0.53~2.06), suggesting no statistical difference in prognosis existing between comprehensive bladder preservation thera-py and radical cystectomy (Z=0.13, P=0.89). Conclusion For some patients with muscle-invasive bladder cancer, the comprehensive bladder preservation therapy does not reduce the 5-year survival rate, can retain normal bladder function, and improve quality of life. However, the indications should be carefully considered.
展开▼
