T_1期低级别膀胱癌电切术后吉西他滨灌注临床效果分析:67例单中心经验

Clinical analysis of gemcitabine perfusion after resection of T_1 low grade bladder cancer:single center experience of 67 cases

目的:比较膀胱癌术后行吉西他滨(GEM)或表柔吡星(EPI)灌注的临床结局。方法:选择2014年1月1日~2016年1月1日于我院诊治的膀胱肿瘤患者,入选标准:膀胱灌注GEM或者EPI;病理分期为pT1期低级别的患者;排除标准:膀胱全切;病理分期pT1期高级别以上患者;其他灌注药物或未行灌注患者。结果:共入组264例患者,中位随访16(3~26)个月,其中行GEM灌注67例(GEM组),行EPI灌注197例(EPI组);GEM组发热患者22例(32.8%),EPI组发热患者30例(15.2%),两组比较差异有统计学意义(P<0.05);GEM组出现明显膀胱刺激症状15例(22.4%),EPI组23例(11.7%),两组比较差异有统计学意义(P<0.05);GEM组中位灌药时间(26.3±16)min,EPI组中位灌药时间(31.2±17)min,两组比较差异有统计学意义(P<0.05);GEM组灌药后血尿7例(10.4%),EPI组灌药后血尿21例(10.7%),两组比较差异无统计学意义(P>0.05);GEM组患者中位肿瘤无复发生存期为10.9个月,EPI组患者中位肿瘤无复发生存期为9.7个月,两组比较差异有统计学意义(P<0.05);GEM组随访期内复发14例(20.9%),EPI组随访期内复发49例(24.9%),两组比较差异无统计学意义(P>0.05)。结论:与灌注EPI患者相比,膀胱癌术后行GEM灌注者有较为明显的不良反应,但有更长的肿瘤无复发生存期,可以综合考虑患者的临床基本情况选择合适的灌注药物。

Objective：To compare the different clinical outcomes of perfusion between gemcitabine and epirubicin for bladder cancer.Method：From January 1 st,2014 to January 1 st,2016,the bladder tumor patients who were diagnosed and treated in our center were selected.The inclusion criteria were：intravesical instillation of epirubicin or gemcitabine,T1 and low grade tumor stage.The exclusion criteria were as follows：cystectomy,pathological staging more than high grade pT1,other perfusion drugs or without perfusion.Result：A total of 264 patients were enrolled,and the median follow-up period was 16（range,3-26）months.Among them,67 patients received gemcitabine perfusion,197 patients received intravesical instillation of epirubicin.In the gemcitabine infusion group,22（32.8%）patients experienced fever,while 30（15.2%）patients experienced fever in the epirubicin perfusion group（P〈0.05）.There were 15（22.4%）patients with obvious bladder irritation symptoms in the gemcitabine perfusion group,while 23（11.7%）patients in the epirubicin perfusion group（P〈0.05）.The median perfusion time was（26.3±16）min in the gemcitabine group,while the median perfusion time was（31.2±17）min in the epirubicin group,（P〈0.05）.In the gemcitabine perfusion group,7（10.4%）patients suffered from hematuria,while 21（10.7%）patients did in the epirubicin group（P〉0.05）.The median tumor recurrence free survival was 10.9 months after gemcitabine infusion,while the median recurrence free survival was 9.7 months after epirubicin infusion（P〈0.05）.During the follow-up period,the recurrence rate was 20.9%（14/67）in the gemcitabine perfusion group,while 24.9%（49/197）in the epirubicin group（P〉0.05）.Conclusion：Compared with intravesical instillation of epirubicin for bladder cancer patients,gemcitabine showed more obvious side effects,but it has longer tumor recurrence free survival.Therefore,the appropriate perfusion drugs should be selected according to the basic clinical situation of the patients.