根治性经尿道膀胱肿瘤电切术联合吉西他滨+顺铂方案对肌层浸润性膀胱癌患者保留膀胱的疗效观察

Efficacy of TURBT combined with GC chemotherapy for bladder preservation in MIBC

目的比较根治性经尿道膀胱肿瘤电切术(TURBT)联合吉西他滨+顺铂(GC)方案全身静脉化疗与根治性膀胱切除术(RC)联合GC方案全身静脉化疗治疗T2N0M0~T3N0M0期肌层浸润性膀胱癌(MIBC)的临床疗效和远期生存率。方法回顾性分析2013年3月至2018年10月我科收治97例T2N0M0~T3N0M0期MIBC患者的临床和随访资料。分为保膀胱组39例,应用TURBT联合GC方案全身静脉辅助化疗保膀胱方案;根治组58例,应用RC联合GC方案全身静脉辅助化疗方案。对比两组患者围手术期相关指标、术后并发症、化疗毒副作用、肿瘤复发、转移及远期生存率等指标。结果保膀胱组多项围手术期指标优于根治组,术后并发症中肠梗阻及淋巴漏的发生率低于根治组(P<0.05)。术后随访时间2~68个月,中位随访时间为34个月。保膀胱组患者1、3、5年的生存率97.4%、80.3%、54.6%与根治组患者1、3、5年的生存率90.1%、84.4%、52.3%相近,差异未见统计学意义(P>0.05)。两组患者术后化疗期间出现骨髓抑制、胃肠道反应等现象,经过对症处理后均缓解。结论根治性TURBT联合GC方案全身辅助化疗保膀胱方案治疗T2N0M0~T3N0M0期MIBC,其远期生存率与RC相比未见明显差异,术后多项远期治疗指标优于根治组,保留了膀胱功能和男性性功能,从而改善其生活质量,各方面都显示了该保膀胱治疗方案的有效性与优越性。

Objective To compare the clinical efficacy and long-term survival rate of patients with T2N0M0~T3N0M0 stage muscle-invasive bladder cancer(MIBC)treated with radical transurethral resection of bladder tumor(TURBT)combined with Gemcitabine and Cisplatin(GC)chemotherapy and radical cystectomy(RC)combined with GC chemotherapy.Methods The clinical and follow-up data of 97 cases of T2N0M0~T3N0M0 stage MIBC treated during Jan.2013 and Oct.2018 were retrospectively analyzed.Patients were divided into two groups:TURBT+GC group(n=39)and RC+GC group(n=58).The perioperative indicators,postoperative complications,toxic and side effects of chemotherapy,tumor recurrence,metastasis and long-term survival rate of the two groups were compared.Results Many perioperative indicators were better in TURBT+GC group than in RC+GC group(P<0.05).The patients were followed up for 2-68 months with a median of 34 months.The 1-year,3-year and 5-year survival rates of TURBT+GC group were 97.4%,80.3%and 54.6%,respectively,which were similar to those of RC+GC group(90.1%,84.4%,52.3%,P>0.05).Bone marrow suppression and gastrointestinal reactions occurred during chemotherapy in both groups,which were alleviated after symptomatic treatment.Conclusion TURBT+GC treatment is safe and effective.It not only achieves a similar survival rate with RC+GC treatment,but also outperforms the latter in a number of perioperative indicators,significantly improving patients'quality of life.