局部晚期膀胱癌术前动脉灌注新辅助化疗的安全性与疗效分析

Safety and efficacy of intra-arterial infusion neoadjuvant chemotherapy for local advanced bladder cancer

目的探讨根治性膀胱切除术前动脉灌注化疗治疗局部晚期膀胱癌的安全性与疗效。方法局部晚期膀胱癌患者（T2～T4a）19例，采用2-脱氧2，2-盐酸二氟脱氧胞苷（β-异构体）与（顺）二氨二氯铂（GC）方案髂内动脉灌注化疗1～3次，随后行膀胱根治性切除术或经尿道膀胱肿瘤电切术，2例肿瘤缩小者拒绝手术治疗，2例经术前评价不能承受手术治疗。统计学分析比较化疗前后患者血自细胞、红细胞、血小板水平，肝肾功能，肿瘤大小、分期及病理分级的变化。结果19例患者化疗前后白细胞计数分别为（6．63±2．58）×10^9／L、（5．12±2．91）×10^9／L，差异无统计学意义（P=0．13）；红细胞计数分别为（4．41±0．52）×10^12／L、（3．92±0．42）×10^12／L，差异有统计学意义（P=0．00）；血小板计数分别为（220．50±59．86）×10^9／L、（157．05±56．72）×10^9／L，差异有统计学意义（P=0．001）；丙氨酸氨基转移酶（ALT）分别为（20．00±8．31）、（26．88±17．04）U／L，差异无统计学意义（P=0．08）；SCr分别为（95．82±14．57）、（88．04±17．76）μmol／L，差异无统计学意义（P=0．06）；肿瘤最大径分别为（3．72±1．23）、（2．80±1．29）cm，差异有统计学意义（P=0．02）。13例根治性切除术患者中降期9例，临床分期与病理分期相符4例；化疗前后细胞分级符合者4例，Ⅰ级转为Ⅱ级者4例，Ⅱ级转Ⅲ级者4例，Ⅲ级转为Ⅱ级1例。结论GC方案动脉灌注新辅助化疗治疗局部晚期膀胱癌，患者耐受性好，未对化疗后手术治疗造成不良影响；多数患者出现肿瘤体积缩小，TNM分期降期；部分敏感患者可选择行保留膀胱的手术。

Objective To evaluate the safety and efficacy of intra-arterial infusion neoadjuvant chemotherapy in local advanced bladder cancer. Methods Nineteen cases with T2--T4a bladder cancer were enrolled in this study. Intra-arterial infusion chemotherapy with Gemcitabine and Cisplatin （GC）were performed for 1 to 3 cycles before radical cystectomy. Postoperative values of hematological parameters, maximum diameter of tumors, TNM（tumor,node and metastasis）stages and pathological grades were compared with preoperative parameters of the same case. Results Compared to the values before GC chemotherapy, WBC count showed no significant change post-operative, （6. 63 ±2.58） ×10^9/L vs（5.12±2.91） ×10^9/L（P=0.13）;RBC（4. 41＋_0. 52）×10^12/L vs（3. 92±0. 42）×10^12/L（P= 0.00） and platelet count（220.50±59.86）×10^9/L vs （157.05±56. 72）×10^9/L（P=0. 001）showed significant decrease;ALT did not show significant decrease（20. 00±8. 31 vs 26. 88±17.04 U/L,P=0.08）;Creatitine also showed no significant change（95.82±14. 57 vs 88.04± 17. 76 μmol/L, P= 0.06） ; Maximum diameter of tumors decreased significantly（3.72± 1.23 vs 2. 80± 1.29 cm,P=0.02）. Compared with clinical TNM stages, pathological TNM stages demonstrated significant decrease in 9 cases;While cell differentiation did not show decrease. Conclusions Intra-arterial infusion with GC regi men can reduce tumor size,decrease TNM stages,while not causing significant adverse impact to radi cal cystectomy. Bladder-spare treatment is an option for chemotherapy sensitive cases.