二次TURBT联合表柔比星、吉西他滨序贯膀胱灌注治疗T_1期高危膀胱癌的临床疗效  

Clinical study on epirubicin plus gemcitabine bladder instillation for T_1 high-risk NMIBC after re-TURBT

作　　者：曹敬毅[1] 王乾[1] 吴刚[1] 王淇超[1] 

机构地区：[1]徐州市肿瘤医院泌尿外科,江苏徐州221005

出　　处：《临床泌尿外科杂志》2016年第7期622-624,共3页Journal of Clinical Urology

基　　金：2013年徐州市科委资助课题(编号XN13B082)

摘　　要：目的：评价二次TURBT联合表柔比星（EPI）与吉西他滨（GEM）序贯膀胱灌注治疗T1期高危膀胱癌的安全性及有效性。方法：选取初次行TURBT治疗的病理分型为T1期高危（G2、G3）膀胱尿路上皮癌患者56例,随机分为三组。EPI组17例,给予EPI50mg膀胱灌注,每周1次共6次;GEM组19例,给予GEM1 000mg膀胱灌注,每周1次共6次;EPI＋GEM组20例,给予EPI50mg、GEM1 000mg膀胱灌注,每周1次共6次。三组术后6周均采用二次TURBT治疗,比较三组的病理分级、临床分期改变及灌注化疗不良反应的差异。随访周期12~24个月,比较三组无复发生存率及进展率的变化。结果：EPI组、GEM组、EPI＋GEM组病理分级下降率分别为35.3%（6/17）、36.8%（7/19）及45%（9/20）,EPI＋GEM组明显高于其他两组,差异有统计学意义（P〈0.05）。EPI组、GEM组、EPI＋GEM组不良反应发生率为11.8%、10.4%、10.0%,差异无统计学意义（P〉0.05）。2年肿瘤无复发生存率EPI组、GEM组、EPI＋GEM组为70.6%（12/17）、73.7%（14/19）、80.0%（16/20）,EPI＋GEM组明显高于其他两组,差异有统计学意义（P〈0.05）。EPI组、GEM组、EPI＋GEM组膀胱癌进展率分别为5.9%、5.2%、5.0%,各组进展率差异无统计学意义（P〉0.05）。结论：对T1期高危膀胱尿路上皮癌患者采用二次TURBT术联合EPI、GEM序贯膀胱灌注化疗,术后病理分级下降,2年复发率降低,较单用EPI及GEM具有较好的临床疗效,但不能改变膀胱癌的进展。Objective：To observe the efficacy and safety of high risk T1 non-muscle invasive bladder cancer（NMIBC）patients treated with sequential intravesical chemotherapy by epirubicin（EPI）and gemcitabine（GEM）.Method：Pathological downstaging and adverse effects were analysed in 20 patients who received 6-week treatments with sequential intravesical chemotherapy GEM（1g）and EPI（50 mg）.These 20 patients were compared with control groups including EPI and GEM patients respectively.Furthermore,2-year recurrence-free survival and progression rates were also compared among three groups.Result：The pathology downstaging for EPI,GEM,EPI＋GEM group were 35.3%（6/17）,36.8（7/19）,45%（9/20）respectively,and the statistical difference was significant（P〈0.05）.However,there was no difference in adverse effect among three groups（P〉0.05）.Twoyear recurrence-free survival rates for EPI,GEM,EPI＋GEM were 70.6%（12/17）,73.7%（14/19）,80.0%（16/20）（P〈0.05）.The progression rates for EPI,GEM,EPI＋GEM were 5.9%,5.2%,5.0%（P〉0.05）.Conclusion：The treatment of re-TURBT and sequential intravesical combination chemotherapy using GEM and EPI appears to fit high-risk T1 NMIBC patients.

关 键 词：非肌层浸润性膀胱癌 高危 二次经尿道膀胱肿瘤电切术 序贯灌注 

分 类 号：R737.14[医药卫生—肿瘤]