羟基喜树碱术后即刻灌注联合维持灌注预防非浸润性膀胱癌复发的长期疗效分析

Long-term Outcomes of Immediate Instillation Combined with Conventional Instillations of high-dose Hydroxycamptothecin for Prevention of Postoperative Recurrence of Non-invasive Bladder Cancer

目的:总结大剂量羟基喜树碱即刻灌注联合维持灌注预防非肌层浸润性膀胱癌术后复发的疗效。方法:回顾性分析了167例中、高危非肌层浸润性膀胱尿路上皮癌患者的临床资料.男性116例,女性51例,平均年龄51岁。所有患者均经病理诊断证实,分期为Ta71例、T_196例,分级为G_166例、G_250例、G_351例。患者行经尿道膀胱肿瘤电切术后即刻膀胱内灌注羟基喜树碱40mg,保留20～30 min,术后1w开始羟基喜树碱维持灌注,40 mg/次,1次/w×8次,以后1次/月×10次,每次维持2 h。结果:155例患者获得随访,平均随访期92(72～112)个月。患者1、2和5年肿瘤复发率分别为23.2%、31.6%和41.3%。治疗的长期预后因素包括肿瘤的分级、分期、数目和大小。本组中膀胱Ⅰ、Ⅱ和Ⅲ度不良反应的发生率为13.5%、3.2%和1.9%,未见Ⅳ度不良反应。全身不良反应仅见Ⅰ度不良反应,发生率为1.3%。结论:大剂量羟基喜树碱即刻灌注联合维持灌注预防膀胱癌术后复发的长期疗效较为满意,不良反应发生率低,患者多能良好耐受治疗。

Objective： To analyze the long-term results of high-dose hydroxycamptothecin （ HCPT ） immediate intravesical instil- lation combined with conventional intravesical instillations for preventing postoperative recurrence of non-muscle invasive bladder can- cer. Methods： The clinical data of 167 patients with intermediate and high-risk urothelial tumor of the bladder treated with transurethral resection of bladder tumor （ TUR-Bt ） were reviewed. A total of 116 males and 51 females were identified, with a median age of 51 years, and diagnosed pathologically. Seventy-one patients had pathological stage of T~ and 96 had T~. Sixty-six had grade l, 50 had grade 2, and 51 had grade 3. Intravesical instillation of 40 mg HCPT was immediately administered postoperatively and retained in the bladder for 20 to 30 min. Conventional intravesical instillations were performed 1 wk post-TUR-Bt. HCPT （ 40 mg ） were given once a wk for 8 wk, then monthly for 10 months, and retained for 2 h at each instance. Results： One hundred and fifty-five patients were fol- lowed up. The mean follow-up time was 92 months （ 72 months to 112 months ）. The 1-, 2-, and 5-year recurrence rates were 23.2%, 31.6%, and 41.3%, respectively. The long-term prognostic factors of recurrence were grades, stages, numbers, and diameters of tumors. The incidence rates of grades [, II, and l]I local toxic effects were 13.5%, 3.2%, and 1.9%, respectively. No grade IV local toxic ef- fects were observed. Only grade I systemic toxic effects were seen in our series, with an incidence rate of 1.3%. Conclusion： Immedi- ate instillation combined with conventional instillations of high-dose HCPT is effective for long-term prevention of post-operative recur- rence of non-muscle invasive bladder cancer. This procedure could be tolerated by most patients, with few side effects.