TURBT术后即刻灌注吡柔比星预防肌层浸润性膀胱癌复发的疗效及安全性观察

Efficacy and Safety of Immediate Pirarubicin Intravesical Instillation After TURBT in the Prevention of Recurrence of Muscle Invasive Bladder Cancer

目的评估TURBT术后即刻膀胱灌注吡柔比星对预防肌层浸润性膀胱癌复发的疗效及安全性。方法回顾性分析我院于2013年1月至2019年6月收治的64例肌层浸润性膀胱癌病例资料。治疗模式均为TURBT+膀胱灌注。治疗组(n=26)术后24 h内行膀胱灌注,对照组(n=38)术后24~48 h内行膀胱灌注。比较两组1、3、6、12个月复发率,对比肿瘤分期进展和不良反应发生情况。结果治疗组术后1、3、6个月复发率(11.54%,23.08%,38.46%)明显低于对照组(44.74%,63.16%,65.79%),差异有统计学意义(P<0.05);两组术后12个月复发率相似(61.54%vs.60.53%,P>0.05);治疗组发热(38.46%)及膀胱刺激征(42.31%)发生率与对照组(26.32%,23.68%)比较差异无统计学意义(P>0.05);治疗组血尿发生率高于对照组(61.54%vs.26.32%,P<0.05);两组肿瘤分期进展(23.08%vs.31.58%)比较差异无统计学意义(P>0.05)。结论肌层浸润性膀胱癌TURBT术后即刻灌注吡柔比星可显著降低肿瘤早期复发率,提高患者早期获益,不会增加患者肿瘤分期进展风险,值得临床借鉴,但可能增加患者血尿的发生率。

Objective To assess the clinical efficacy and safety of immediate pirarubicin intravesical instillation after transurethral resection of bladder tumor(TURBT)in the prevention of recurrence of muscle invasive bladder cancer(MIBC).Methods The clinical data of 64 patients with MIBC treated in our hospital from January 2013 to June 2019 were analyzed retrospectively,all patients underwent TURBT+intravesical instillation,in whom there were 26 patients treated with pirarubicin intravesical instillation within 24h(treatment group)and 38 patients treated with pirarubicin intravesical instillation within 24~48 h(control group).The recurrence rate of 1-month,3-month,6-month,12-month after the treatment,the progress of tumor stage,the adverse reactions after intravesical instillation were compared between two groups.Results The 1-month recurrence rate(11.54%),3-month recurrence rate(23.08%)and 6-month recurrence rate(38.46%)in treatment group were significantly lower than control group(44.74%,63.16%,65.79%),comparison has statistically significant(P<0.05);the 12-month recurrence rate between two groups(61.54%vs.60.53%)has no statistically significant(P>0.05);there was no significant difference in tumor stage progression between two groups(23.08%vs.31.58%,P>0.05);the incidence of fever(38.46%)and bladder irritation(42.31%)in treatment group is similar to control group(26.32%,23.68%)with no significant difference(P>0.05);the incidence of hematuria in treatment group is significantly higher than control group(61.54%vs.26.32%,P<0.05).Conclusion Immediate pirarubicin intravesical instillation after TURBT can reduce the early tumor recurrence rate and increase the benefits in those patients with MIBC,which will not increase the rate of tumor stage progression,worthy of clinical reference,but may increase the incidence of hematuria.