腹壁下动脉插管化疗配合手术治疗对膀胱肿瘤预后的影响

Influence of preoperative inferior-epigastric arterial chemotherapy combinating with operation on prognosis of transitional cell carcinoma of urinary bladder

目的:探讨术前腹壁下动脉插管化疗(IAC)配合手术治疗对膀胱移行细胞癌预后的影响。方法:对128例膀胱移行细胞癌患者先行盆腔区域化疗,再行开放手术(复合组);对照组134例仅行单纯开放手术。采集术后肿瘤标本,采用流式细胞术(FCM)行肿瘤细胞核DNA含量测定;全部病例随访5年,比较随访资料。结果:在Ⅱ、Ⅲ级膀胱移行细胞癌中,复合组的DNA指数(DI)、增殖指数(PI)、S期比率(SFR)、异倍体率4项指标明显优于对照组(P<0.05)。复合组的5年生存率82.8%(108/128),复发率17.9%(14/128);单纯手术对照组5年生存率44.0%(59/134),复发率40.2%(54/134),两组比较差异具有显著性(P<0.05)。结论:术前动脉化疗配合手术治疗对Ⅱ、Ⅲ级膀胱移行细胞癌肿瘤DNA含量影响显著,可以提高患者的生存率,降低复发率。

Objective：To evaluate the influence of inferior epigastric arterial chemotherapy （IAC） of bladder transitional cell carcinoma and the prognosis of bladder cancer patients. Methods：In chemotherapy group, a total of 128 cases of the bladder cancer patients underwent partial cystectomy after preoperative arterial chemotherapy were selected. While in contrast group, a total of 134 cases of bladder cancer patients underwent open surgery alone were selected. All the tissue samples were selected for detection of the kayron DNA content by flow cytometry （FCM）. All these cases were followed up for 5 years. Results：By contrasting the DNA iHdcx（DI）, proliferation index（PI）, S-stage Rate（SFR）, aneuploid rate, we found that in the cases of grades Ⅱ and Ⅲ bladder cancer, there was a statistically significant difference （P〈0.05） between those with and without arterial chemotherapy. The 5-year survival rate was 82.8%（108/128） for the patients who received arterial chemotherapy combined with operation, the recurrent rate was 17.9%（14/128）. However, The 5 year survival rate was 44.0%（59/134） for the patients who underwent simply partial cystectomy, and the recurrent rate was 40.2% （51 13,1）. in the operation alone group（P〈0.05）. Conclusions：The arterial chemotherapy might significantly influence the DNA content of Ⅱ and Ⅲ bladder cancer, and might increase the survival rate of bladder cancer patients, decrease the recurrent rate.