早期吡柔比星膀胱灌注与常规膀胱灌注预防浅表性膀胱癌术后复发的疗效及毒性比较的Meta分析

A Meta-analysis of the comparative immediately intravesical instillation of pirarubicin versus traditional intravesical instillation of pirarubicin for bladder cancer

目的比较吡柔比星早期膀胱灌注与常规灌注对表浅性膀胱癌术后复发的预防和毒性作用。方法检索国内外关于术后吡柔比星早期膀胱灌注与常规灌注治疗表浅性膀胱癌的比较研究,按预设的标准进行筛选纳入5项研究进行质量评价,并提取数据进行Meta分析。结果吡柔比星早期膀胱灌注对预防浅表性膀胱癌术后复发的疗效优于常规灌注组,差异有统计学意义,其优势比及95%可信区间分别为0.45、0.26～0.77(P=0.003<0.05)。治疗毒性主要是尿路刺激征/腺性膀胱炎。Meta分析显示总的尿路刺激征的发生率在早期灌注组较常规灌注组显著降低,其优势比及95%可信区间分别为0.63、0.41～0.95(P=0.03<0.05)。结论吡柔比星早期膀胱灌注预防浅表性膀胱癌复发的疗效明显优于常规灌注,毒性作用显著低于常规灌注组。因纳入研究有限,建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。

Objective To compare the prophylactic efficacy and toxicity of immediately intravesical instillation of pirarubicin versus traditional intravesical instillation of pirarubicin on recurrence of bladder cancer.Methods We retrieved published comparative studies on immediately intravesical instillation of pirarubicin versus traditional intravesical instillation of pirarubicin for bladder cancer,and pooled the data from Meta-analysis.Results 5 trials including were eligible to the inclusion criteria.Pooling data of a meta-analysis indicated that immediately intravesical instillation of pirarubicin was statistically significantly superior to traditional intravesical instillation of pirarubicin in the prophylaxis of tumor recurrence（OR 0.45、95% CI 0.26～0.77,P=0.0030.05）.The incidence of the toxicity mainly cystitis/ urinary irritation symptoms were significantly lower in immediately intravesical instillation group than traditional intravesical instillation group（OR 0.63,95%CI 0.41～0.95,P=0.030.05）.Conclusions The resuits of this meta—analysis suggest the significant superiority of immediately intravesical instillation of pirarubicin compared with traditional intravesical instillation for the prevention of tumor recurrence.Because of few studies and small samples,more high quality trials with large samples and longer following-up are proposed