肾盂高级别尿路上皮癌伴脉管侵犯术后吉西他滨加顺铂化疗的临床疗效观察

Clinical observation on the therapeutic efficacy of postoperative GC regimen chemotherapy for upper tract urothelial carcinoma with renal pelvic high-grade and vascular invasion

目的探讨肾盂高级别尿路上皮癌伴脉管浸润患者术后辅助吉西他滨加顺铂(gemcitabine and cisplatin,GC)化疗对患者肿瘤复发进展以及生存的影响。方法回顾性分析2017年10月至2021年5月期间宿迁市第一人民医院及贵州医科大学附属肿瘤医院行腹腔镜肾—输尿管—膀胱袖状切除术后的高级别肾盂尿路上皮癌伴脉管侵犯44例患者,分为试验组及对照组,试验组患者术后行GC方案化疗,对照组患者术后进行常规膀胱灌注治疗,随访3年评价试验组及对照组患者的膀胱内及对侧尿路复发率及患者1年及3年生存情况。结果试验组与对照组膀胱内复发情况对比差异无统计学意义(P>0.05);对侧尿路复发率试验组低于对照组,差异有统计学意义(P<0.05);1年及3年生存率试验组高于对照组,差异有统计学意义(P<0.05)。结论对于脉管侵犯的高级别肾盂尿路上皮癌患者术后行GC方案化疗相较于常规膀胱灌注,能够有效预防肿瘤进展,提高患者生存预后。

Objective To explore the effect of postoperative adjuvant chemotherapy with gemcitabine plus cisplatin(GC)on tumor recurrence,progression,and survival in patients with upper tract urothelial carcinoma(UTUC)with renal pelvic high—grade and vascular invasion.Methods A retrospective analysis was conducted on 44 patients with high-grade UTUC with renal pelvic invasion who underwent laparoscopic nephrotireterectomy and bladder cuff excision in The First People's Hospital of Suqian and The Afliated Cancer Hospital of Guizhou Medical University between October 2017 and May 2021.The patients were divided into a GC group and a control group,with the former receiving GC regimen chemotherapy and the latter receiving routine bladder irrigation treatment after siargery.The bladder and contralateral urinary tract recurrence rates and the 1-year and 3-year survival rates were evaluated after a 3-year follow-up.Results There was no significant difference in bladder recurrence rates between the GC group and the control group(P>0.05),while the contralateral urinary tract recurrence rate in the GC group was lower than that in the control group,with a statistically significant difference(P<0.05).The 1-year and 3-year survival rates in the GC group were higher than those in the control group,with statistically significant differences(P<0.05).Conclusion For high-grade UTUC patients with vascular invasion,postoperative GC regimen chemotherapy can effectively prevent tumor progression and improve patient survival compared to routine bladder irrigation treatment.