髂内动脉化疗栓塞治疗肌层浸润性膀胱肿瘤远期效果分析

Long-term efficacy of transurethral resection combined with intra-arterial chemotherapy in treating muscle-invasive bladder cancer

目的：探索最大限度TURBT＋膀胱灌注化疗＋髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤的远期效果。方法：收集2003～2014年,福建省立医院收治确诊T2～3N0M0,但无上尿路梗阻的膀胱移行细胞癌患者。将行根治性全膀胱切除术的患者归积极组;将因各种原因改行姑息性治疗的患者归为保守组,姑息性治疗包括最大限度经尿道膀胱肿瘤电切、规律的表阿霉素膀胱灌注化疗,联合术后髂内动脉栓塞化疗。对比两组生存差异。结果：共入选患者90例,行根治性全膀胱切除术的患者66例,行姑息治疗的患者24例（26.7%）。中位随访时间50个月。生存分析结果显示,行根治性膀胱全术的积极组,中位无瘤生存时间为63个月（95%CI 40.3-85.6个月）,中位总生存时间尚未到达;保守组的中位无瘤生存时间为21月（95%CI 6.7-35.3个月）,中位总生存时间为54个月（95%CI 41.9-66.2个月）;两组间对比,无瘤生存时间差异有统计学意义,63vs.21个月,P=0.002;中位总生存时间差异无统计学意义,NA vs.54个月,P=0.057。结论：最大限度TURBT＋膀胱灌注化疗＋髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤尽管相比根治性治疗更容易复发或进展,但其远期疗效尚可,可以作为因各种原因不能接受根治手术患者保留膀胱的治疗方案之一。

Objective：To assess the long-term efficacy of intra-arterial chemotherapy in patients with muscleinvasive bladder cancer following TURBT.Method：From 2003 to 2014,patients with complete follow-up data were enrolled.Inclusion criteria were pathological diagnosis of bladder transitional cell carcinomas,clinical stage T2-3N0M0,without upper urinary tract obstruction.Patients were divided into two groups.Patients of group A underwent radical cystectomy,while patients of group B underwent maximum TURBT,regular intravesical instillation and intra-arterial chemotherapy.Their progression free survival（PFS）and overall survival were compared between two groups.Result：A total of 90 patients were enrolled.Group A has 66 patients,and group B has 24.The median follow-up period was 50 months.There was significant statistical difference in PFS between group A and B（63vs.21 months,P =0.002）,but there was no significant statistical difference in overall survival（not reached vs.54 months,P =0.057）.All patients in group B completed the treatment with mild complication.Conclusion：Though tumor recurrence or progression may be more likely to be found,patients can still obtain longterm benefit from maximum TURBT combined with intravesical instillation and intra-arterial chemotherapy.This bladder preservation strategy can offer another option for patients with muscle-invasive bladder cancer who are unable or unwilling to undergo radical treatment.