保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床研究

The outcome of bladder-sparing surgery combined with intra-arterial chemotherapy for invasive bladder cancer

目的评价保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床疗效。方法2003年4月-2006年12月,对35例浸润性膀胱癌患者采用经尿道膀胱肿瘤电切或膀胱部分切除术联合GC(吉西他滨+顺铂)方案动脉化疗治疗,总结分析肿瘤控制情况、膀胱保存率和患者的生存率。结果33例患者获随访,2例失访,平均随访24.3个月(3-45个月)。27例无瘤生存,2例带瘤生存,4例死于肿瘤转移,2年生存率为88.8%;19例无复发及转移,5例浅表性复发,3例浸润性复发,6例转移;25例保留膀胱生存,4例行挽救性全膀胱切除,4例死亡,2年膀胱保存率为74.1%。全部患者对动脉化疗耐受良好,无严重全身和局部不良反应。结论保留膀胱手术联合GC方案动脉化疗治疗浸润性膀胱移行细胞癌近期疗效满意,毒副作用轻,值得临床进一步观察研究。

Objective To evaluate the clinical effect of bladder- sparing surgery combined with intra -arterial chemotherapy for patients with invasive bladder cancer. Methods From April 2003 to December 2006, 35 patients with invasive bladder cancer were treated with transurethral resection of bladder tumor or partial cystectomy combined with intra - arterial chemotherapy. The chemotherapy regimen consisted of gemcitabine and cisplatin （GC）. The tumor control, bladder preservation and survival rate of these patients were analysised. Results 33 patients were followed up for 3 - 45 months while 2 lost. Twenty - seven ot 33 patients survived without tumor and 2 patients survived with tumor. Four patients died of metastatic disease. The 2 - year survival rate was 87.9%. 19 patients survived without relapse or metastasis. Superficial relapse occurred in 5 patients and muscle - invasive relapse occurred in 3 patients. 6 patients developed metastasis. 25 patients survived with functional bladder. Salvage cystectomy were performed for local failure in 4 patients. The 2 - year survival rate with bladder - preservation was 74. 1%. Intra - arterial chemotherapy with GC regimen was well tolerated without severe systemic or local toxicities. Conclusion Bladder - sparing surgery combined with intra - arterial chemotherapy with GC regimen is effective for invasive bladder transitional cell carcinoma with little toxicity and good tolerability. But the long - term outcome of this treatment protocol needs further study.