比较吡柔比星和丝裂霉素C在膀胱癌电切术后膀胱灌注化疗安全性与疗效的Meta分析

Comparison on the efficiency and safety of intravesical chemotherapy between THP and MMC in prevention of recurrence of bladder cancer after transurethral resection of bladder tumor: meta-analysis

目的:评估吡柔比星和丝裂霉素C在膀胱癌电切术后行膀胱灌注化疗的安全性与有效性。方法:计算机检索2005~2017年国内外公开发表的对比吡柔比星与丝裂霉素C在膀胱癌电切术后膀胱灌注化疗安全性与有效性的研究文献,运用Cochrane系统评价方法,对符合纳入标准的资料采用Rev Man 5.3软件进行Mate分析。结果:15项研究符合纳入标准,共1 189例患者,其中吡柔比星组624例,丝裂霉素C组565例。Meta分析结果显示:吡柔比星组和丝裂霉素C组1年肿瘤复发率比较差异有统计学意义(OR=0.34,95%CI:0.22~0.53,P<0.05);2年肿瘤复发率比较差异有统计学意义(OR=0.34,95%CI:0.25~0.47,P<0.05);3年肿瘤复发率比较差异有统计学意义(OR=0.32,95%CI:0.19~0.56,P<0.05)。吡柔比星组和丝裂霉素C组全身不良反应发生率比较差异有统计学意义(OR=0.33,95%CI:0.21~0.51,P<0.05);膀胱刺激征发生率比较差异有统计学意义(OR=0.51,95%CI:0.37~0.71,P<0.05);总不良反应发生率比较差异有统计学意义(OR=0.29,95%CI:0.17~0.47,P<0.05)。结论:相比于丝裂霉素C,吡柔比星在膀胱肿瘤电切术后灌注化疗预防肿瘤复发上更具优势,吡柔比星膀胱灌注后不良反应较丝裂霉素C更轻微。

Objective:To evaluate the safety and efficiency of intravesical chemotherapy with pirarubicin and mitomycin C after transurethral resection of bladder tumor.Method:We searched the domestic and abroad published literature on comparison of safety and efficiency of intravesical chemotherapy between pirarubicin and mitomycin C after transurethral resection of bladder tumor from 2005 to 2017 by computer.Then we used the evaluating method of Cochrane system and Rev Man 5.3 software to analyse the data in conformity with the inclusion criteria(Mate Analysis).Result:A total of 15 pieces of literature had been involved.There were 1 189 patients(624 were treated with pirarubicin and 565 with mitomycin C).The meta-analysis results showed the comparison of 1-year recurrence rate,OR=0.34,95%CI:0.22-0.53,P<0.05;comparison of 2-year recurrence rate,OR=0.34,95%CI:0.25-0.47,P<0.05;comparison of 3-year recurrence rate,OR=0.32,95%CI:0.19-0.56,P<0.05.The comparison of incidence of systemic adverse reactions,OR=0.33,95%CI:0.21-0.51,P<0.05;the comparison of incidence of bladder irritation,OR=0.51,95%CI:0.37-0.71,P<0.05;the comparison of total rate of adverse reactions,OR=0.29,95%CI:0.17-0.47,P<0.05.Conclusion:Compared with mitomycin C,pirarubicin has a certain advantage in preventing recurrence after transurethral resection of bladder tumor.Also,the adverse reaction of pirarubicin after intravesical chemotherapy is more mild than mitomycin C.