保留膀胱手术联合动脉插管化疗对高危非肌层浸润性膀胱癌的疗效研究

The clinical study of intra-arterial chemotherapy followed by bladder-preserving surgery for high-risk non muscle-invasive bladder cancer

目的：研究保留膀胱手术联合动脉插管化疗对高危非肌层浸润性膀胱癌的疗效.方法回顾性分析2012年1月至2014年12月于我院行保留膀胱手术的58例高危非肌层浸润性膀胱癌患者的临床资料,58例患者术后随机纳入动脉插管化疗组和膀胱灌注组,定期随访,观察比较两组患者的复发率、进展率、无复发生存率、无肿瘤进展生存率和毒副作用等.结果经过10~46（中位时间25）个月的随访,动脉化疗组（27例,平均随访23.7个月）1例复发,复发率为3.7％,平均无肿瘤复发生存时间为（38.2±0.8）个月；无肿瘤进展,肿瘤进展率为0.膀胱灌注组（31例,平均随访25.7个月）10例复发,复发率为32.3％,平均无肿瘤复发时间为（29.7±2.3）个月；5例肿瘤进展（侵犯肌层或远处转移）,进展率为16.1％.两组无复发生存率分别为95.7％、37.0％,无肿瘤进展生存率分别为100％、66.7％,两两比较,差异均有统计学意义（分别P＝0．006,P＝0．030）.结论保留膀胱手术的高危非肌层浸润性膀胱癌患者联合动脉插管化疗相比单纯行膀胱灌注化疗能有效降低膀胱癌复发及进展的风险.

Objective To study the efficacy of intra-arterial chemotherapy followed by blad-der-preserving surgery for high-risk non muscle-invasive bladder cancer （NMIBC）. Methods From January 2012 to December 2014,58 patients which were all diagnosed with NMIBC by bladder-preserving surgery （TURBT or partial cystectomy）randomly divided into 2 groups,27 patients （age 34-87 years,22 male and 5 female）were given intra-arterial chemotherapy （gemcitabine＋cisplatin＋epirubicin）combined with intravesical chemotherapy （epirubicin or THP）,and 31 patients （51-90 years,29 male and 2 female）received intravesical chemotherapy alone.Recurrence rate,progression rate,time to first recurrence,tumor progression-free survival rate,and adverse reactions were com-pared between two groups. Results After 10-46 （median,25）months followed-up,the recurrence rate of the intra-arterial chemotherapy （mean,23.7 months）and the intravesical chemotherapy （mean,25.7 months）groups were 3.7%（1/27）and 32.3%（10/31）,respectively. The no tumorre-currence survival time of the two groups were （38.2±0.8）months and （29.7±2.3）months respec-tively. The overall recurrence-free rate were 95.7%,37.0%（P=0.006）of the two groups. The progression rate were 0 （0/27）and 16.1%（5/31）,respectively. The tumor progression-free surviv-al rate were 100%,66.7% （P=0.030）. Conclusions This study suggest that intra-arterial chem-otherapy followed by bladder-preserving surgery for NIMBC is more effective in preventing from re-currence and progression compared with intravesical chemotherapy alone.