原发性上尿路上皮癌术后膀胱灌注化疗在预防膀胱癌复发中的作用——系统综述及Meta分析  

Role of intravesical chemotherapy in preventing recurrence of bladder tumor after radical nephroureterectomy for upper tract urothelial carcinoma:A systematic review and Meta-analysis

作　　者：黎桂源 蒋双键 莫承强[1] 唐一鸣 桂程鹏 丘少鹏[1] LI Gui yuan;JIANG Shuang-jian;MO Cheng-qiang;TANG Yi-ming;GUI Cheng-peng;QIU Shao-peng(Department of Urology,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院泌尿外科

出　　处：《现代泌尿外科杂志》2019年第9期733-740,共8页Journal of Modern Urology

摘　　要：目的通过Meta分析评估膀胱内化学药物灌注在预防上尿路上皮癌(UTUC)行根治性肾输尿管切除术(RNU)后膀胱肿瘤复发中的作用。方法在2018年9月,使用MEDLINE、EMABASE和Cochrane图书馆数据库以及CNKI和万方数据进行全面的文献检索。所有临床试验均限于原发性UTUC在RNU术后行预防性膀胱内化学药物灌注的疗效对比,为扩大纳入范围及纳入病例数,不限制原文献语种。提取的数据使用Stata 15SE软件进行分析。结果本研究共纳入2 270例患者,其中1 283例在RNU术后接受膀胱灌注治疗,987例仅行RNU治疗。荟萃分析表明:预防性膀胱灌注化疗可有效预防原发性UTUC患者术后膀胱癌复发(OR=0.42,95%CI0.34~0.52,P<0.001);多次灌注疗效优于单次灌注,但无统计学差异(OR=0.668,95%CI:0.42~1.062;P=0.088);单用羟基喜树碱(HCPT)或吡柔比星(THP)灌注组的OR为0.31(95%CI:0.17~0.54),而单用丝裂霉素C(MMC)或表柔比星(EPI)灌注组的OR为0.52(95%CI:0.39~0.71)。结论预防性膀胱灌注化疗可明显降低UTUC术后膀胱肿瘤复发率。就预防膀胱癌复发疗效而言,多次灌注优于单次灌注,THP或HCPT灌注优于MMC或EPI。病理分级为G1~G3的患者术后行膀胱灌注化疗均可获显著疗效。由于样本量及研究证据等级所限,以上结果仍有待大样本、高质量的随机对照试验进一步证实。Objective To evaluate the role of intravesical chemotherapy in preventing recurrence of bladder tumor(BT)after radical nephroureterectomy(RNU)for upper tract urothelial carcinoma(UTUC)by Meta-analysis.Methods In Sept.2018,the clinical trials comparing the efficacy of prophylactic intravesical chemotherapy after RNU for primary UTUC were searched in MEDLINE,EMABASE,Cochrane Library databases,CNKI and Wanfang Data.There was no limit on the original languages of the published papers.The data collected were analyzed with Stata 15 SE software.Results A total of 2 270 patients were included,1 283 of whom received intravesical instillation after RNU,while 987 received RNU only.Meta-analysis showed that prophylactic intravesical chemotherapy could effectively prevent BT recurrence in patients with primary UTUC(OR=0.42,95%CI:0.34-0.52,P<0.001);repeated instillations were superior to single instillation,but there was no statistical difference(OR=0.668,95%CI:0.42-1.062;P=0.088);the ORfor monotherapy of hydroxycamptothecin(HCPT)or pirarubicin(THP)was 0.31(95%CI:0.17-0.54),while that of mitomycin-C(MMC)or epirubicin(EPI)was 0.52(95%CI:0.39-0.71).Conclusion Preventive intravesical chemotherapy can significantly reduce BT recurrence after RNU.In terms of prophylactic efficacy,repeated instillations are superior to single instillation,and THP or HCPT is better than MMC or EPI.Patients of varied pathological grades all benefit from preventive intravesical chemotherapy.Due to the limited sample size and the evidence level of primitive research,the above results still need further confirmation by well-designed randomized controlled trials.

关 键 词：膀胱肿瘤复发 膀胱灌注化疗 荟萃分析 肾输尿管切除术 上尿路上皮癌 

分 类 号：R737[医药卫生—肿瘤]