表柔比星联合吉西他滨序贯化疗治疗非肌层浸润性膀胱癌术后患者的疗效及生存分析

Effect of sequential chemotherapy with epirubicin and gemcitabine in patients with non-muscle-invasive bladder cancer after operation and the survival analysis

目的探讨非肌层浸润性膀胱癌(NMIBC)患者术后采用表柔比星与吉西他滨序贯化疗的疗效及生存情况。方法采用随机数字表法将100例NMIBC患者分为序贯组和对照组,每组50例。序贯组采用膀胱灌注表柔比星与吉西他滨序贯化疗,对照组采用膀胱灌注表柔比星单独化疗。比较化疗前后两组患者的血清Dickkopf相关蛋白1(DKK1)、人类软骨糖蛋白39(YKL40)水平,并对两组患者化疗期间不良反应发生率和3年无瘤生存情况进行比较。结果化疗前,两组患者血清DKK1、YKL40水平比较,差异均无统计学意义(P﹥0.05)。化疗后,两组患者的血清DKK1、YKL40水平均较本组化疗前降低(P﹤0.05);化疗后,序贯组患者的血清DKK1、YKL40水平均明显低于对照组(P﹤0.01)。化疗期间,两组患者的肝肾功能损害、骨髓抑制、脱发、恶心呕吐、尿痛发生率比较,差异均无统计学意义(P﹥0.05)。序贯组患者的3年无瘤生存率为71.70%,高于对照组的56.60%,差异有统计学意义(P﹤0.05)。结论NMIBC患者术后采用表柔比星与吉西他滨序贯化疗可以降低血清中DKK1和YKL40水平,且对延长肿瘤复发时间具有一定的作用。

Objective To investigate the effect of sequential chemotherapy with epirubicin(EPI)and gemcitabine(GEM)after operation for non-muscle-invasive bladder cancer(NMIBC),and to investigate the survival of patients.Method A total of 100 NMIBC patients were randomly assigned to sequential therapy group and control group with 50 cases in each.Sequential therapy group received sequential chemotherapy of EPI plus GEM while the control group received intravesical EPI chemotherapy alone.The levels of Dickkopf-related protein 1(DKK1)and human cartilage glycoprotein-39(YKL40)in serum of patients before and after chemotherapy were compared between the two groups,the incidence of adverse reactions and 3-year tumor-free survival were compared between the two groups additionally.Result Before chemotherapy,there was no significant difference in the serum DKK1 and YKL40 levels between the two groups(P>0.05);after chemotherapy,the serum levels of DKK1 and YKL40 in both groups were significantly decreased(P<0.05);and they were significantly lower in sequential therapy group than those in the control group(P<0.01).During chemotherapy,the incidences of hepatic and renal dysfunction,bone marrow suppression,alopecia,nausea and vomiting,and dysuria were similar between the two groups(P>0.05).The tumor-free survival rate in sequential therapy group was71.70%,which was higher than the 56.60%in control group,with significant difference(P<0.05).Conclusion Sequential chemotherapy with EPI and GEM after surgery for NMIBC patients has favorable effect on reducing serum DKK1 and YKL40 levels,and may delay the time to recurrence.