新辅助化疗联合经尿道膀胱肿瘤电切术对膀胱癌病人肿瘤直径、尿液膀胱肿瘤抗原水平及复发率的影响

Effects of neoadjuvant chemotherapy combined with transurethral resection of bladder tumor on tumor diameter,urine BTA level and recurrence rate in patients with bladder cancer

目的新辅助化疗联合经尿道膀胱肿瘤电切术(TURBT)对膀胱癌病人肿瘤直径、尿液膀胱肿瘤抗原(BTA)水平及复发率的影响。方法2017年2月~2018年9月本院收治的肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)病人83例,根据治疗方法不同分为两组,A组41例,实施TURBT治疗,B组42例,先行开展新辅助化疗,再行TUBRT。术后所有病人均行膀胱灌注化疗。测定B组病人化疗前、化疗3个周期后肿瘤直径,统计B组不良反应情况,记录两组手术指标,检测两组入组时、术后6个月尿膀胱肿瘤抗原(BTA)、核基质蛋白22(NMP-22)水平,比较两组远期存活率及复发率。结果B组病人化疗后肿瘤最大直径、最小直径分别为(2.68±0.73)cm和(1.53±0.47)cm,化疗前分别为[(3.49±0.81)cm和(2.35±0.69)cm,治疗前后比较差异有统计学意义(P<0.05);B组化疗后通常出现血液系统、消化道反应,以轻度为主,病人均可耐受;B组手术用时、术中失血量分别为(47.11±6.03)min,(52.43±5.62)ml,A组分别为(52.75±8.42)min,(61.16±7.58)ml,两组比较差异有统计学意义少(P<0.05);术后A组尿BTA、NMP-22水平分别为(6.86±1.50)U/L和(10.24±2.03)U/ml;B组分别为(4.61±1.27)U/L和(6.58±1.42)U/ml,入组时A组分别为(13.89±2.62)U/L和(26.57±2.71)U/ml;B组分别为(14.73±2.95)U/L和(27.26±3.92)U/ml,两组均明显降低,差异有统计学意义(P<0.05),且B组均明显较A组低,差异有统计学意义(P<0.05);B组1年、2年及3年存活率分别为95.24%、90.48%、83.33%,A组分别为80.49%、70.73%、63.41%,两组比较差异有统计学意义(P<0.05);B组1年、2年及3年复发率分别为4.76%、11.19%、19.05%,A组分别为21.95%、34.15%、39.02%,两组比较差异有统计学意义(P<0.05)。结论先对MIBC病人实施新辅助化疗可有效缩小肿瘤,再开展TURBT,可缩短手术用时,降低术中出血量,提高远期存活率,降低复发率。

Objective To investigate the effects of neoadjuvant chemotherapy combined with transurethral resection of bladder tumor(TURBT)on tumor diameter,urine bladder tumor antigen(BTA)level and recurrence rate in patients with bladder cancer.Methods A retrospective analysis was conducted on the clinical data of 83 patients with myometrial invasion and bladder cancer(MIBC)admitted to our hospital from February 2017 to September 2018,and they were divided into group A(n=41)and group B(n=42)according to different treatment methods.Group A was treated with TURBT,group B was treated with neoadjuvant chemotherapy on the basis of group A,and all patients received intravesical chemotherapy after operation.The tumor diameters of group B before chemotherapy and after 3 cycles of chemotherapy were measured,the toxic and side effects of group B were counted,the operation indexes of the two groups were recorded,the levels of urinary bladder tumor antigen(BTA)and nuclear matrix protein 22(NMP-22)were detected when the two groups were enrolled and 6 months after the operation,and the long-term survival rate and recurrence rate of the two groups were understood.Results The maximum diameter and minimum diameter of the tumor[(2.68±0.73)cm,(1.53±0.47)cm]after chemotherapy in group B were significantly smaller than those before chemotherapy[(3.49±0.81)cm,(2.35±0.69)cm](P<0.05).Patients in group B usually had blood system and digestive tract reactions after chemotherapy,mainly mild,which could be tolerated by patients,the operation time and blood loss[(47.11±6.03)min,(52.43±5.62)ml]in group B were significantly less than that in group A[(52.75±8.42)min,(61.16±7.58)ml](P<0.05).The levels of urine BTA and NMP-22[group A:(6.86±1.50)U/L,(10.24±2.03)U/ml;group B:(4.61±1.27)U/L,(6.58±1.42)U/ml]in the two groups after operation were significantly lower than those at the time of entry[group A:(13.89±2.62)U/L,(26.57±2.71)U/ml;group B:(14.73±2.95)U/L,(27.26±3.92)U/ml](P<0.05),and group B were significantly lower than group A(P<0.05).The 1-year,2-year,and 3-year survival rates of group B were 95.24%,90.48%and 83.33%,respectively,which were significantly higher than the group A(80.49%,70.73%and 63.41%,P<0.05).The 1-year,2-year,and 3-year recurrence rates in group B were were 4.76%,11.19%and 19.05%,respectively,which were significantly lower than the group A(21.95%,34.15%and 39.02%,P<0.05).Conclusion Firstly,neoadjuvant chemotherapy for MIBC patients can effectively shrink tumors,and then TURBT can significantly shorten the operation time,significantly reduce the amount of intraoperative blood loss,and help improve the long-term survival rate and reduce the recurrence rate.