吉西他滨与羟基喜树碱对非肌层浸润性膀胱癌灌注化疗效果的回顾分析

Retrospective analysis of the effects of gemcitabine and hydroxycamptothecin-instillation chemotherapy on non-muscle-invasive bladder carcinoma

目的比较吉西他滨与羟基喜树碱对非肌层浸润性膀胱癌(NMIBC)术后膀胱灌注化疗的治疗效果。方法 2013年10月至2015年10月于我院因NMIBC行经尿道膀胱肿瘤电切手术并完成术后膀胱灌注化疗的219例患者纳入研究,219例患者分为低危即刻组、低危即刻+维持组、中危组及高危组,用卡方检验方法对各组患者术后2年内肿瘤复发率进行分析,对数秩检验法比较各组肿瘤无复发生存时间并绘制Kaplan-Meier生存曲线。结果低危即刻组、低危即刻+维持组中经吉西他滨灌注化疗的患者2年内复发率及肿瘤无复发生存时间与经羟基喜树碱灌注者比较,差异无统计学意义(P>0.05),而中危组及高危组中,经吉西他滨灌注患者术后2年内复发率明显低于经羟基喜树碱灌注者(P<0.05),且术后肿瘤无复发生存时间较羟基喜树碱灌注者更长(P<0.05)。对于所有低危NMIBC患者,使用同一种灌注药物时,即刻+维持灌注组2年内复发率及肿瘤无复发生存时间与即刻灌注组无明显差异(P>0.05),但前者局部不良反应发生率明显高于后者(P<0.05)。灌注方法一致时,患者局部不良反应发生率与所用药物无明显关联(P>0.05)。结论针对中、高危NMIBC患者,吉西他滨较羟基喜树碱有显著优势,而低危NMIBC,我们更倾向于选择术后即刻灌注治疗。

Objective To compare the effect between gemcitabine and hydroxycamptothecin instillation in non-muscle-invasive bladder cancer（NMIBC）after surgery. Methods From October 2013 to October 2015,219 patients with NMIBC who underwent transurethral resection of tumor in our hospital were reviewed in this study.All patients were divided into low risk immediate instillation group,low risk immediate instillation combined with conventional instillations group,middlerisk group and high-risk group.The chi-square test was used to analyze the tumor recurrence rate in each group within 2 years after operation.Then we used log-rank test to analyze the tumor recurrence-free survival time of each group and drew Kaplan-Meier survival curve. Results In low risk immediate instillation group and low risk immediate instillation combined with conventional instillations group,the two-year relapse rates and recurrence-free survival time patients treated with gemcitabine were similar to those patients treated with hydroxycamptothecin（P〉0.05）.In middle-risk group and high-risk group,the recurrence rates in 2 years of patients after gemcitabine instillation were significantly lower than those after instillation with hydroxycamptothecin（P〈0.05）,and the postoperative recurrence-free survival time of them was longer than those after hydroxycamptothecin infusion（P〈0.05）.For all low-risk NMIBC patients,the recurrence rate and recurrence-free survival within 2 years after immediate instillation combined conventional instillations were not significantly different from those after immediate instillation with the same drug（P〉0.05）,but the incidence of local side effects was significantly higher than immediate instillation（P〈0.05）.When the perfusion method was consistent,there was no significant correlation between the incidence of local side effects and the drugs used（P〉0.05）. Conclusions This retrospective analysis showed that for middle and high risk NMIBC patients,gemcitabine had a significant advantage over hydroxycamptothecin,while for low risk NMIBC,we prefered to choose immediate postoperative perfusion.