经尿道膀胱肿瘤切除术后补救性动脉介入化疗治疗肌层浸润性膀胱癌的疗效分析  

Efficacy of salvage intra-arterial chemotherapy after transurethral resection of bladder tumor for muscle invasive bladder cancer

作　　者：梁胜杰[1] 邹青松[1] 韩邦旻[1] 邵怡[1] 荆翌峰[1] 赵福军[1] 刘海涛[1] 夏术阶[1] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科,上海200080

出　　处：《临床泌尿外科杂志》2013年第10期755-757,共3页Journal of Clinical Urology

摘　　要：目的:探讨补救性髂内动脉化疗在经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)后证实为肌层浸润性膀胱癌患者中的治疗价值。方法:对34例TURBT患者术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤患者行补救性髂内动脉化疗3次,方案为顺铂80mg、表柔吡星50mg、5-氟尿嘧啶1g(或羟基喜树碱30mg)。观察患者肿瘤复发率,Kaplan-Meier法计算总体生存率,肿瘤特异性生存率,无肿瘤复发生存率,并绘制生存曲线。结果:术后经3次补救性髂内动脉化疗及常规膀胱灌注后,29例患者得到保留膀胱(保留膀胱率85.3%),肿瘤复发13例(肿瘤复发率38.2%)。其中,浅表性复发7例,行TURBT治疗;浸润性复发5例,行全膀胱切除术;骨转移1例,行全身化疗。总体生存率:3年69.78%,5年62.03%。肿瘤特异性生存率:3年77.43%,5年68.83%。无肿瘤复发生存率:1年93.10%,2年70.23%,3年46.82%。结论:补救性动脉介入化疗是TURBT术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤的良好选择。Objective： To explore the therapeutic value of salvage intra-arterial chemotherapy after transure- thral resection of bladder tumor （TURBT） for patients diagnosed with muscle invasive bladder cancer. Method： Thirty-four patients whose biopsy of the base of tumor and pathology after TURBT confirmed muscle invasive bladder cancer underwent salvage intra-arterial chemotherapy three courses. The chemotherapy regimen consisted of cisplatin 80 mg, Epirubicin 50 mg and 5-fluorouracil 1 g/hydroxy camptothecin 30 rag. The rates of recurrence of the tumors were observed. Kaplan-Meier analysis was used to calculate the overall survival. The cancer specific survival, recurrence-free survival rates and survival curve were recorded. Result： After three courses of postopera- tive salvage intra-arterial chemotherapy and intravesical therapy, 29 patients preserved their bladder （85.3 %）, re- currence has occurred in 13 cases （38.2~/00）. Among these patients, seven cases with superficial recurrence under- went TURBT; five cases with invasive recurrence underwent radical cystectomy; one case underwent intravenous chemotherapy because of bone metastasis. The overall survival rates at three and five years were 69. 78~/oo and 62.03 }/0 respectively. The cancer-specific survival rates at three and five years were 77.43 ~ and 68.83 ~ respec- tively. The recurrence-free survival rates at one, two and three years were 93.10%, 70.23% and 46.82~/00 respec- tively. Conclusion： Salvage intra-arterial chemotherapy is a good choice for patients whose biopsy of the base of tumor and pathology after TURBT confirmed muscle invasive bladder cancer.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤切除术 肌层浸润 动脉化疗 

分 类 号：R737.14[医药卫生—肿瘤]