单次丝裂霉素C膀胱灌注预防中、低风险浅表性膀胱癌复发

Immediate single mitomycin C intravesical chemotherapy for prophylaxis of low-and intermediate-risk superficial bladder cancer recurring

目的探讨丝裂霉素C术后即刻单次灌注预防中、低风险浅表性膀胱癌的远期疗效。方法采用前瞻性研究方法,随访5年。81例中、低风险浅表性膀胱癌随机分为3组。A组术后6h内丝裂霉素C80mg单次灌注;B组术后第10天开始灌注丝裂霉素C,每次40mg,每周1次,共8周;C组术后第10天每周灌注丝裂霉素C1次,每次40mg,8周后改为每月1次,每次40mg,总时间1年。结果随访5年,81例入选病例中失访8例。A、B、C组各1例T1期膀胱癌患者死于膀胱癌复发及转移。3组术后2年复发率分别为23.8%、25.0%和21.4%,5年复发率分别为42.9%、33.3%和39.3%,各组2年和5年复发率差别经χ2检验均无统计学意义。A、B、C3组不良反应发生率分别为28.6%、33.3%和32.1%,经χ2检验差别无统计学意义。结论丝裂霉素C术后即刻单次灌注毒副作用小,可以有效预防中、低风险浅表性膀胱癌的复发。术后密切随访是浅表性膀胱癌治疗方案的重要组成部分。

[Purpose] To discuss the role of single Mitomycin C intravesical chemotherapy for reducing recurrence of low-and intermediate-risk superficial bladder cancer following by TURBT. [Methods] Prospective, randomized and controlled approaches were adopted in this clinical study. Total 81 cases of low-and intermediate-risk superficial bladder cancer were assigned to 3 groups randomly. All the patients received standard transurethral resection of bladder cancer. The patients of A group received 80 mg MMC intravesical instillation within 6 hours postoperatively. Patients of group B began MMC intavesical chemotherapy on the 10 th day following by TURBT, The dose of every treatment was 40mg with 1 week interval, lasting for 8 weeks. The patients of C group received the same management as the group B during the first 8 weeks with additional monthly MMC 40 mg intravesical instillation for 1 year. Outcomes of tumor recurrence and side effects of the management were collected and analyzed after 5 years following-up from Aug, 1995 to Apr, 2001. [Results] Of 81 patients, 8 cases were lost to follow-up. 3 cases died of tumor metastasis during following-up, belonging to A, B, C group, respectively. All the died cases had pathologic stage of T1. The recurrence rate of 3 groups was 23.8%, 25.0% and 21.4% at 2 year, respectively. However, The recurrence rate of 3 groups rose to 42.9%, 33.3% and 39.3% at 5 year respectively. There was no significant difference among 3 groups on the tumor recurrence. The rate of adverse effect associated with intravesical chemotherapy of 3 groups was 28.6%, 33.3% and 32.1%, respectively. No significant difference was demonstrated.[Conclusions] To some extent, immediate single MMC intravesieal therapy following by TURBT could prevent low-and intermediate-risk superficial bladder cancer from recurring effectively with little side effects. Close follow-up plays an important role in the management of superficial bladder cancer.