选择性膀胱部分切除术联合膀胱灌注化疗治疗肌层浸润性膀胱癌疗效及预后影响因素

The effect and affecting factors of muscle-invasive bladder cancer patients treated by partial cystectomy combined with bladder perfusion chemotherapy

目的 探讨选择性膀胱部分切除术（PC）联合膀胱灌注化疗治疗肌层浸润性膀胱癌（MI-BC）疗效及预后影响因素.方法 回顾性收集本院收治的55例肌层浸润性膀胱癌患者临床资料,所有患者均接受PC联合膀胱灌注化疗治疗,并进行随访观察5年癌特异性生存率、总生存率和复发率,先采用单因素分析5年癌特异性生存率的可能影响因素后行多因素Logistic回归分析.结果 55例患者随访时间10 ～ 60个月,中位随访时间44个月,5年癌特异性生存率、总生存率和复发率分别为72.73％（40例）、61.82％（34例）和30.91％（17例）;x2检验显示,年龄≥60岁、T3分期、有膀胱肿瘤史、肿瘤多发、肿瘤≥5cm患者5年癌特异性生存率显著降低,而联合输尿管再植术（UR）治疗患者5年癌特异性生存率显著升高,差异均有统计学意义（P＜0.05）;多因素Logistic回归分析显示,肿瘤≥5cm,肿瘤多发,T3分期是肌层浸润性膀胱癌预后的危险因素,会降低癌特异性生存率,而联合UR治疗则是其保护因素,能增加癌特异性生存率.结论 PC联合膀胱灌注化疗是治疗MIBC可行的保留膀胱术式,联合UR治疗可以改善预后,而肿瘤≥5cm、多发以及T3分期的患者5年癌特异性生存率明显降低,不推荐行保留膀胱手术。

Objectives To explore the efficacy and affecting factors of muscle-invasive bladder cancer （MIBC） patients treated by partial cystectomy （PC） combined with bladder perfusion chemotherapy.Methods To retrospectively collect the clinical data of 55 cases MIBC patients from hospital secondly uropoiesis surgical department,and all patients were treated by PC combined with bladder perfusion chemotherapy,observed with the 5 years cancer specific survival,overall survival and relapse rate,selected the potiential influence factors of 5 years before cancer specific survival using the single factor analysis,then used the logistic regression analysis.Results The follow-up time was 10 to 60 months,the median follow-up time was 44 months,the 5 years cancer specific survival,overall survival and relapse rate were respectively 72.73% （40 cases） 、61.82% （34cases） and 30.91% （17cases）,x2 test showed that petients whose age ≥ 60,T3 stage,had a history of bladder tumor,multiple tumor,tumor ≥ 5 cm,their 5 years cancer specific survival significantly reduced,and combined with ureteral reimplantation （UR） treatment the 5 years cancer specific survival significantly rised,the difference had statistical significance （P 〈 0.05）;Multiariable Logistic regression analysis showed that tumor ≥5 cm,multiple tumor,muscular T3 stage were risk factors for invasive bladder cancer prognosis,they could reduce cancer specific survival rate,and combined therapy with UR was its protection factor,it could increase cancer specific survival.Conclusions PC combined with bladder perfusion chemotherapy is a feasible retention bladder surgery on treating MIBC,combined with UR treatment can improve prognosis,and the 5 years cancer specific survival in patients with tumor≥5 cm,multiple and T3 stage are decreased obviously,we will not reconmended preserve bladder surgery.