经尿道同期手术治疗非肌层浸润性膀胱癌及前列腺增生对膀胱癌复发影响的Meta分析

The effect of simultaneous transurethral resection of non-muscle invasive bladder cancer and prostate on tumor recurrence:aMeta-analysis

目的通过Meta分析评价经尿道膀胱肿瘤切除术（TURBT）和前列腺增生切除术（TURP）同期进行对手术后膀胱癌的总体复发率情况及前列腺窝或膀胱颈部肿瘤复发率情况的影响。方法检索国内外有关经尿道同期手术治疗非肌层浸润性膀胱癌及前列腺增生对术后肿瘤复发影响的对照研究的论文,无论是否采用分配隐藏、盲法等研究方法。由2名评价人员独立按照Cochrane系统评价方法对文献开展质量方面的评估与分析,收集所需资料后,采用Review Manager 5.3版本的统计学方面的技术软件对所收集的资料展开Meta分析和研究。结果共纳入10个对照研究试验的1 603例患者。试验组共721例,57例发生前列腺窝/膀胱颈部复发,293例发生肿瘤复发。对照组共882例患者,67例发生前列腺窝/膀胱颈部复发,396例发生肿瘤复发。结果显示：同期进行经尿道膀胱肿瘤切除术和前列腺增生切除术与单独进行经尿道膀胱肿瘤切除术相比较,手术后两组患者发生前列腺窝或者膀胱颈部肿瘤复发的情况没有统计学差异（P〉0.05）。比较两组肿瘤总体复发率情况,OR值为0.74（0.60~0.91）（P=0.005）,表明同期手术组的肿瘤总体复发率比对照组显著降低。而将试验组中前列腺窝/膀胱颈部肿瘤复发率与术前肿瘤数目的相关性进行比较,OR值为0.25（0.12~0.52）（P=0.0002）,表明多发肿瘤术后,前列腺窝/膀胱颈部的肿瘤复发率明显增高。结论经尿道同期手术治疗非肌层浸润性膀胱癌和前列腺增生不会增加前列腺窝/膀胱颈部肿瘤复发的机率和种植风险,且随访期内,同期手术组的肿瘤总体复发率比对照组显著降低;两手术可以同时进行。

Objective To evaluate the tumor recurrence and prostatic fossa/bladder neck tumor recurrence rate of simultaneous transurethral resection of bladder tumor（TURBT）and transurethral resection of prostate（TURP）.Methods Literature of domestic and foreign comparative studies of simultaneous TURBT and TURP（treatment group）versus TURBT alone（control group）were retrieved.According to the Cochrane system evaluation method,two independent evaluators evaluated the data,using Review Manager version 5.3 statistical technical software for Meta-analysis.Results A total of 10 clinical trials with1 603 patients were included.In the treatment group,57 cases had recurrence of prostatic fossa/bladder neck,293 cases had tumor recurrence.Average follow-up time was 43.55 months（range：12 to 130 months）.In the control group,67 cases had recurrence of prostatic fossa/bladder neck,396 cases had tumor recurrence.Average follow-up time was 47.24months（range：12 to 191 months）.There was no statistically significant differences（P〉0.05）between the two groups in the recurrence of prostatic fossa/bladder neck.Comparison of the tumor recurrence showed the OR value was 0.74（0.60~0.91）（P=0.005）,indicating that the simultaneous surgery had a low rate of tumor recurrence.Comparison of the prostatic fossa/bladder neck recurrence showed the OR value was 0.25（0.12~0.52）（P=0.000 2）,indicating that the multiple tumors cases had a high rate of recurrence.Conclusions The simultaneous TURBT and TURP will not increase the risk of prostatic fossa/bladder neck tumor recurrence.During the follow-up,the simultaneous surgery shows a low rate of tumor recurrence.TURBT and TURP can be performed at the same time.