髂内动脉化疗栓塞在极高危非肌层浸润性膀胱癌经尿道电切术后的应用及价值  

Application and clinical value of intra-arterial chemoembolization via internal iliac artery in treating extremely high-risk non-muscle invasive bladder cancer after trans-urethral resection

作　　者：汪磊[1] 陈佳 李志虎 王刚[1] 果宏峰[1] 张侃玺 何山[2] 李宁忱 WANG Lei;CHEN Jia;LI Zhihu;WANG Gang;GUO Hongfeng;ZHANG Kanxi;HE Shan;LI Ningchen(Department of Urology,Shougang Hospital of Peking University,Wujieping Urology Center of Peking University,Beijing 100144,China)

机构地区：[1]北京大学首钢医院泌尿外科,吴阶平泌尿外科医学中心,100144 [2]北京大学首钢医院肿瘤科,100144 [3]宁夏回族自治区固原市人民医院泌尿外科

出　　处：《介入放射学杂志》2020年第10期988-992,共5页Journal of Interventional Radiology

基　　金：北京市石景山区医学重点支持专科建设项目(2018004);北京大学首钢医院临床重点项目(SGYYZ201604)。

摘　　要：目的极高危非肌层浸润性膀胱癌具有很高的复发和进展风险。明确双侧髂内动脉化疗栓塞术(IAC)经尿道电切术后辅助措施的价值。方法回顾性分析2015年1月至2017年12月收治的该类患者38例,均接受经尿道膀胱肿瘤电切术及术后规律膀胱灌注治疗(卡介苗或表柔吡星/吡柔吡星),根据是否接受IAC分为IAC组及对照组。IAC组在电切术后2周内接受第1疗程IAC,再间隔3~4周行第2疗程IAC,化疗方案:顺铂60 mg/m2,吡柔比星25 mg/m2。术后随访指标包括无复发生存时间、随访期间进展率及切除膀胱率等。结果IAC组12例,对照组26例,平均随访时间(30.1±12.4)个月。IAC组与对照组在主要观察指标上的比较如下:无复发生存时间(20.3±14.1)个月比(8.9±7.2)个月,(P=0.002),1年无复发生存率66.7%比26.9%,(P=0.02),2年无复发生存率33.3%比7.7%,(P=0.07),随访期间进展率33.3%比46.2%,(P=0.46),切除膀胱率25.0%比46.2%,(P=0.21)。结论对于极高危非肌层浸润性膀胱癌患者,在经尿道电切术后辅助双侧髂内动脉化疗栓塞有助于延缓疾病的复发。Objective Extremely high-risk non-muscle invasive bladder cancer(NMIBC)carries a very high risk of recurrence and progression after trans-urethral resection.The purpose of this study is to clarify whether intra-arterial chemoembolization(IAC)via bilateral internal iliac arteries,which is used as an auxiliary measure after trans-urethral resection of bladder tumor(TURBt),can benefit patients or not.Methods The clinical data of a total of 38 admitted patients with extremely high-risk NMIBC,who received TURBt and subsequent regular intra-vesical perfusion(using BCG vaccine or epirubicin/pirarubicin)during the period from January 2015 to December 2017,were retrospectively analyzed.Depending on whether IAC was adopted or not,the patients were divided into IAC group(n=12)and control group(n=26).For the patients of IAC group,the first course of IAC was performed within 2 weeks after TURBt,and after 3-4 weeks the second course of IAC was carried out.The chemotherapy regimen included cisplatin 60 mg/m2 and pirarubicin 25 mg/m2.After the treatment,the patients were followed up to observe the clinical results,and the recurrence-free survival time,progression rate and cystectomy rate were calculated.Results IAC group had 12 patients,and control group had 26 patients.The mean follow-up time was(30.1±12.4)months.In IAC group and control group,the recurrence-free survival time was(20.3±14.1)months and(8.9±7.2)months respectively(P=0.002),the oneyear recurrence-free survival rate was 66.7%and 26.9%respectively(P=0.02),the 2-year recurrence-free survival rate was 33.3%and 7.7%respectively(P=0.07);and during the follow-up period,the progression rate was 33.3%and 46.2%respectively(P=0.46),the cystectomy rate was 25.0%and 46.2%respectively(P=0.21).Conclusion For the treatment of extremely high-risk NMIBC,TURBt followed by IAC via bilateral internal iliac arteries is helpful for delaying the recurrence of the disease.(J Intervent Radiol,2020,29:988-992)

关 键 词：极高危 非肌层浸润性膀胱癌 髂内动脉化疗栓塞术 复发 根治性膀胱切除 

分 类 号：R694[医药卫生—泌尿科学]