三联膀胱灌注化疗方案对行TURBT术浅表型膀胱癌的疗效

Triple bladder perfusion chemotherapy for superficial bladder cancer patients undergoing TURBT

目的探讨三联膀胱灌注化疗方案对行经尿道膀胱癌电切术(TURBT)浅表型膀胱癌患者复发风险、生存时间及实验室指标的影响。方法选择2015年1月到2016年1月行TURBT治疗的浅表型膀胱癌患者203例,按照患者的化疗方法分为对照组和观察组,其中对照组患者102例采用二联膀胱灌注化疗方案(羟喜树碱+吡柔比星),观察组患者101例采用三联膀胱灌注化疗方案(羟喜树碱+吡柔比星+卡介苗),对两组治疗前后血清分泌型蛋白Dickkopf(DKK)、血管内皮生长因子(VEGF)、成纤维细胞生长因子(FGF)、基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)水平及肿瘤标志物水平[血清角蛋白19片段(CYFRA21-1)和巨噬细胞炎性蛋白-3α(MIP-3α)]进行比较。并分析术后6、12、18、24个月的复发情况及灌注化疗过程中的不良反应。采用K-M法进行生存分析。结果对照组患者术后6、12、18、24个月的复发率均高于观察组,差异有统计学意义(P均<0.01)。治疗后,两组患者DKK、VEGF、FGF、MMP-2、MMP-9水平和CYFRA21-1、MIP-3α水平均较治疗前降低(P均<0.01),且观察组均低于对照组(P均<0.01)。两组患者不良反应发生率比较差异均无统计学意义(P均>0.05)。对照组患者的生存时间为20.480个月(95%CI:19.220~21.739),观察组患者生存时间为22.599个月(95%CI:21.789~23.408),两组差异有统计学意义(χ2=5.805,P<0.05)。结论利用三联膀胱灌注化疗方案干预浅表型膀胱癌患者,可降低患者的复发率,延长患者的生存时间。

Objective To investigate the effects of triple bladder infusion chemotherapy regimen on recurrence risk,survival time and laboratory indicators of patients with superficial bladder cancer undergoing transurethral resection of bladder tumor（TURBT）. Methods A total of 203 patients with superficial bladder cancer treated with TUBRT from January 2015 to January 2016 were selected. According to the chemotherapy method,the patients were divided into control group（n = 102） in which two combination-chemotherapy perfusion regimen（hydroxycamptothecin and epirubicin） was performed and observation group（n = 101） in which triple bladder perfusion chemotherapy [hydroxycamptothecin,epirubicin and Bacillus Calmette Guerin] was performed. The levels of serum secreted protein Dickkopf（DKK）,vascular endothelial growth factor（VEGF）,fibroblast growth factor（FGF）,matrix metalloproteinase-2（MMP-2）,matrix metalloproteinase-9（MMP-9）,serum keratin 19 fragment 21-1（CYFRA21-1）,macrophage inflammatory protein-3 alpha（MIP-3α） were compared between two groups; recurrence at 6-,12-,18-,and 24-month after operation and adverse reactions during perfusion chemotherapy were observed; K-M method was used for survival analysis. Results The recurrence rates in control group were significantly higher than those in observation group at 6-,12-,18-and 24-month after operation（P〈0. 01）. After treatment,the levels of DKK,VEGF,FGF,MMP-2,MMP-9,CYFRA21-1,MIP-3α decreased statistically compared with before treatment in both two groups（P〈0. 01） and were significantly lower in observation group than those in control group（P〈0. 01）. There was no significant difference in the incidence of adverse reactions between two groups（P〉0. 05）. The survival time was 20. 480 months（95% CI： 19. 220-21. 739） in control group and 22. 599 months（95% CI： 21. 789-23. 408） in observation group. There was a significant difference between two groups（χ2=5. 805,P〈0. 05）. Conclusion The use of triple bladder infusion chemotherapy can reduce the recurrence rate,thus to increase the survival time of patients with superficial bladder cancer.