同期经尿道手术治疗浅表性膀胱癌并前列腺增生对肿瘤复发及种植性转移的影响(Meta分析)

The Effect of Simultaneous Transurethral Resection of Bladder Tumor and Prostate on the Tumor Recurrence and Implantation(Meta Analysis)

目的:研究同期经尿道手术治疗浅表性膀胱癌合并前列腺增生对膀胱癌复发率及种植性转移率的影响。方法:检索国内外关于同期经尿道手术与分期手术治疗浅表性膀胱癌并前列腺增生的比较研究,按预设的标准进行筛选,对纳入研究进行质量评价,并提取数据进行统计学分析(Meta分析)。以总复发率及膀胱颈/前列腺窝复发率为终点指标,用优势比(OR)和95%置信区间(CI)评价。结果:共6个研究符合标准被纳入,其中国外5个,国内1个,总病例数761例,其中同期手术组377例,分期手术组384例;最大随访期内分别有36.3%(1 37/377),46.3%(1 78/384)出现复发。Meta分析结果显示同期手术组术后复发率统计学上显著低于分期手术组(OR 0.63,95%CI 0.47～0.86);5%(19/377)的同期手术组患者和4.7%(18/384)分期手术患者发生膀胱颈/前列腺窝复发,两组比较差异无统计学意义(OR 1.09,95%CI 0.55～2.14)。结论:同期经尿道手术治疗浅表性膀胱癌合并前列腺增生可降低肿瘤复发率,而不增加膀胱颈/前列腺窝种植性转移概率。

Objective： To assess the efficacy and safety of simultaneous resection in the treatment of superficial bladder cancer （SBC） with benign prostatic hyperplasia （BPH）. Methods： Combined overseas and domestic published data from comparative studies on simultaneous TURBT and TURP versus TBRBt alone in SBC were retrieved, and the data of eligible studies were pooled （meta-analysis）. Odds ratios （OR） and 95% con？ dence intervals （CI） were used as the primary effect size tO estimate the outcome of tumor recurrence, recurrence in bladder neck/prostatic fossa. Results：In six eligible clinical trials, 377 patients were treated with simultaneous resection and 384 with TURBT alone. Within the follow-up period, 36.3% （137/377）of patients in the simultaneous group and 46.3% （178/384） of the patients in the control group developed tumor recurrence, the combined analysis showed the recurrence of simultaneous group statistically signi？ cant lower than control group in the overall pooled data （OR 0.63,95%CI 0.47-0.86） ; 19（5%） of 377 patients in simultaneous group and 18 （4.7%） of 384 patients in control group developed tumor recurrence in bladder neck/prostatic fossa, no statistically signi？ cant was found in two groups （OR 1.09,95%CI 0. 55-2.14）. Conclusion.- The evidence from this formal meta-analysis suggests that simultaneous TURBT and TURP have decreased the incidence of overall tumor recurrence, while no effect on incidence of implantation in bladder neck/prostatic fossa.