髂内动脉化疗对高危非肌层浸润性膀胱癌患者预后影响分析

Effect analysis of intra-iliac arterial chemotherapy for high-risk non-muscle-invasive bladder cancer

目的:膀胱癌是世界范围内高发恶性肿瘤,其按原发部位浸润情况一般划分为非肌层浸润性膀胱癌和肌层浸润性膀胱癌。其中高危非肌层浸润性膀胱癌由于其高复发率及进展率,长期以来备受临床研究关注。本研究旨在分析髂内动脉化疗在高危非肌层浸润性膀胱癌患者治疗中是否有益。方法:回顾性分析南京大学医学院附属金陵医院2015年6月—2019年12月所有收住入院非肌层浸润性膀胱癌患者,根据欧洲泌尿外科学会指南危险分层将其划分为低危、中危和高危组,进一步将高危组膀胱癌患者按治疗方案不同分为试验组和对照组,其中试验组共35例,患者行髂内动脉化疗+经尿道膀胱肿瘤电切术+膀胱灌注化疗,对照组126例,患者仅行经尿道膀胱肿瘤电切术+膀胱灌注化疗。分析试验组和对照组在肿瘤复发、进展以及生存方面是否存在统计学差异。结果:试验组患者总复发率显著低于对照组(P<0.01),但两组肿瘤进展率及5年特异性生存率比较差异无统计学意义(P>0.05)。结论:髂内动脉化疗是高危膀胱癌保留膀胱治疗安全有效的干预手段,能显著降低患者肿瘤复发率,而在延缓肿瘤进展及远期生存方面是否有优势有待于进一步探究。

Objective: Bladder cancer is the most common malignant tumor in the world, which is generally divided into non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. High-risk non-muscle-invasive bladder cancer has been a hot topic in clinical research for a long time due to its high recurrence and progression rate. The purpose of our study is to investigate the effectiveness and safety of intra-arterial chemotherapy combined with transurethral resection of bladder tumor plus intravesical chemotherapy in high-risk non-muscle-invasive bladder cancer. Methods: All hospitalized patients with non-muscle-invasive bladder cancer in the urology department, Jinling Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. They were divided into low, intermediate and high risk groups according to the European Association of Urology guidelines. Then, patients with high-risk non-muscle-invasive bladder cancer were grouped into test group and control group on the basis of different regimens. There were 35 patients in test group and they received intra-arterial chemotherapy + transurethral resection of bladder tumor + intravesical chemotherapy. Other 126 patients in control group were treated with transurethral resection of bladder tumor + intravesical chemotherapy only. Based on the follow-up results, we would mainly analyze whether patients in test patients were superior to control patients in terms of controlling tumor recurrence and progression and extending patients survival time by statistical approach. Results: Recurrence rate in test group was significantly lower than that in control group(P<0.01). However, there is no significant difference in tumor progression or 5-year cancer specific survival(P>0.05). Conclusion: Intra-iliac arterial chemotherapy is an effective and safe procedure for treatment of high-risk non-muscle-invasive bladder cancer, which can significantly reduce the recurrence rate, and whether there is an advantage in delaying tumor progression and improving long-term survival remains to be further demonstrated.