两种膀胱灌注疗法影响浅表性膀胱癌术后患者生活质量和复发等预后因素的比较

Long-term versus short-term intravesical instillation of pirarubicin in the improvement of postoperative quality of life,recurrence and other prognostic factors in patients with superficial bladder cancer

目的:探讨浅表性膀胱癌术后长期和短期应用吡柔比星膀胱灌注对患者生活质量系数和复发率的影响。方法:纳入解放军总医院泌尿外科2002-04/2005-03浅表性膀胱癌术后患者60例,随机分为改良长期疗法组和短期疗法组,每组30例。改良长期疗法组第1个疗程为8周,行吡柔比星30mg膀胱灌注,1次/周,共8次;第2个疗程为16周,行吡柔比星30mg膀胱灌注每2周1次,共8次;第3个疗程6个月,行吡柔比星30mg膀胱灌注1次/月,共6次;第4个疗程为1年,行吡柔比星30mg膀胱灌注每3个月1次,4次至电切术后2年。短期疗法组疗程为8周,行吡柔比星30mg膀胱灌注,1次/周,共8次。①评价生活质量用自制生活质量量表,包括食欲、精神、睡眠、疲乏、疼痛、泌尿系统排泄、家庭和同事的理解、对癌症的认知、对治疗的态度、日常生活情节10部分。每个项目分5个等级,每个等级标注为1～5分不等,满分50分。②疼痛使用目测类比评分,以10cm垂直线性描述疼痛程度,以患者的感受为标准自己讲述所处疼痛程度并标记分数。分为10个等级,0分为无痛,10分为最痛。③体质量评价通过治疗前后体质量变化,患者治疗后体质量较治疗前增加或减少>3kg为体质量增加或减少;体质量增加或减少≤3kg的患者为体质量稳定。结果:按实际处理分析,术后1年进入结果分析57例,改良长期疗法组28例,短期疗法组29例,术后2年进入结果分析56例,改良长期疗法组27例,短期疗法组29例。①生活质量因子评分:治疗后1和2年改良长期疗法组和短期疗法组疼痛、体质量及生活质量各项指标无差异(P>0.05)。②患者复发率分析:术后1年改良长期疗法组复发与短期疗法组无显著差异犤1例(4%,1/57),2例(7%,2/57),χ2=0.316,P>0.05)犦;术后2年改良长期疗法组复发患者少于短期疗法组犤2例(7%,2/56),9例(34%,9/56),χ2=4.945,P<0.05犦。结论:浅表性膀胱癌术后采用改良的方法长期应用吡柔比星膀胱灌注,肿瘤复发率低于短期应用组,生活质量系数无明显差别。

AIM:To investigate the effect of the improved long-term and short-term intravesical instillation of pirarubicin on coefficient of patients' postoperative life of quality(QOL) and postoperative recurrence of superficial bladder cancer. METHODS:Sixty patients following operation of superficial bladder cancer selected from Department of Urology,General Hospital of Chinese PLA from April 2002 to March 2005 were equally randomized into two groups,improved long-term intravesical instillation of pirarubicin group and short-term intravesical instillation of pirarubicin group.In the former group,patients received intravesical instillation of pirarubicin 30 mg once a week for 8 times totally(8 weeks) as the first course,every two weeks for 8 times(16 weeks) as the second course,once a month for 6 times totally(6 months) as the third course,and also once every three months for 4 times(1 year)as the fourth course till the end of the postoperative second year following electrocision of superficial bladder cancer;In the latter group,patients only received intravesical instillation of pirarubicin 30 mg once a week for 8 times totally(8 weeks).①The patients' postoperative QOL was assessed based on a self-designed QOL scale including appetite,mental status,sleep,tiredness,pain,urinary excretion,understanding from families and colleagues,cognition of cancer,attitude to treatment and plots of daily life,each of the 10 items were graded into 5,and each grade was labeled from 1 to 5 points with the full marks of 50.②Pain in the two groups were assessed with visual analogue scale(VAS),using 10-cm vertical linearity to describe degree of pain and perception complained by patients as the standard to mark degree of pain.It was graded into 10:0 point as painlessness and 10 point as the severest pain.③Patients' body mass was assessed based on the changes of body mass before and after treatment:body mass after treatment increased or decreased more than 3 kg were regarded as increase or decrease of body mass,and that increased or decreased less than or equal to 3 kg as stable body mass. RESULTS:According to the actual management,totally 57 cases were analyzed in the result after 1-year treatment,28 cases in improved long-term intravesical instillation group and 29 in short-term intravesical instillation group.Totally 56 cases were analyzed in the result after 2-year treatment,27 cases in improved long-term intravesical instillation group and 29 in short-term intravesical instillation group.①There was insignificant difference in the pain,body mass and QOL between the groups 1 year or 2 years after treatment(P >0.05).②At 1 year after treatment,the recurrence rate of superficial bladder cancer was 4%(1/57) in the improved long-term intravesical instillation group and 7%(2/57) in the short-term intravesical instillation group,with insignificant difference between them(χ2=0.316,P >0.05);At 2 years after treatment,it was significantly lower in the former group(7%,2/56) than in the latter group(34%,9/56)( χ2 = 4.945,P< 0.05). CONCLUSION:The postoperative recurrence rate of superficial bladder instillation is lower by improved long-term intravesical instillation of THP than by short-term intravesical instillation,and the coefficient of QOL is unremarkably different by the two methods of intravesical instillation.