长期与短期膀胱内灌注表柔比星预防非肌层浸润性膀胱癌复发的比较:Meta分析和系统评价  

Long-term versus short-term epirubicin intravesical instillation for prevention of recurrence of non-muscle-invasive bladder cancer:a meta-analysis and systematic review

作　　者：吴海超 陈振杰 付什 丁明霞[1] 段毅勇 WU Haichao;CHEN Zhenjie;FU Shi;DING Mingxia;DUAN Yiyong(Department of Urology,Second Affiliated Hospital of Kunming Medical University,Kun-ming,650101,China;Department of Urology,Lijiang People's Hospital)

机构地区：[1]昆明医科大学第二附属医院泌尿外科,昆明650101 [2]丽江市人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2021年第10期812-819,共8页Journal of Clinical Urology

基　　金：云南省高校科技创新团队项目[No:云教发(2019)58号]。

摘　　要：目的:目前,关于膀胱内灌注表柔比星(epirubicin,EPI)预防非肌层浸润性膀胱癌(non-muscle-inva-sive bladder cancer,NMIBC)复发的最佳时长仍不清楚,为了了解长期和短期膀胱内灌注EPI治疗NMIBC患者疗效的差别,我们对已发表的临床随机试验结果进行了Meta分析和系统评价。方法:对PubMed、Web of Sci-ence,Cochrane图书馆和Embase数据库进行了搜索,以筛查有关长期与短期膀胱内EPI灌注治疗NMIBC的疗效的研究。纳入分析的仅为随机对照试验(RCT),试验应包含长期灌注和短期灌注2个分组。结果:11项RCT符合该系统评价的条件。Meta分析显示长期EPI膀胱内灌注和短期之间预防肿瘤复发[RR=1.03,95%CI(0.95~1.32),P=0.44]、进展[RR=1.03,95%CI(0.75~1.41),P=0.86]及延长患者生存[RR=1.00,95%CI(0.85~1.15),P=0.96]没有显著差异,而且短期EPI灌注相比长期EPI灌注更具安全性,并发症发生率更低[RR=1.55,95%CI(1.05~2.28),P=0.03]。结论:我们的Meta分析显示,与短期EPI膀胱内灌注相比,长期EPI灌注并没有显示出独特的优势,即短期EPI膀胱内灌注后减少膀胱癌复发和进展的作用与长期相当,而且发生肉眼血尿、排尿痛等副作用的频率较低,程度较轻,在安全性方面更值得信赖。因此目前进行短期EPI膀胱内灌注治疗即可,不过未来应该进行大型的前瞻性研究进一步明确EPI灌注的最佳治疗方案。Objective:At present,The optimal duration of intravesical instillation of epirubicin to prevent re-currence of non-muscle-invasive bladder cancer(NMIBC)remains unclear.In order to understand the difference between long-term and short-term intravesical EPI perfusion in the treatment of NMIBC patients,we conducted a meta-analysis and systematic review of the results of published randomized clinical trials.Methods:PubMed,Web of Science,Cochrane Library and EMBASE databases were searched to screen for studies on the efficacy of long-term and short-term intravesical epirubicin infusion for NMIBC.Only randomized controlled trials(RCTs)were included in the analysis.The trial should include two groups:long-term infusion and short-term infusion.Results:Eleven RCTs met the criteria of the system evaluation.Meta analysis showed that there was no significant differ-ence between long-term EPI intravesical instillation and short-term EPI intravesical instillation in preventing tumour recurrence[RR=1.03,95%CI(0.95-1.32),P=0.44]or progression[RR=1.03,95%CI(0.75-1.41),P=0.86],and there were also no better results in survival[RR=1.00,95%CI(0.85-1.15),P=0.96].However,short-term EPI intravesical perfusion is safer than long-term EPI intravesical perfusion for its lower incidence of complication[RR=1.55,95%CI(1.05-2.28),P=0.03].Conclusion:Our meta analysis shows that compared with short-term EPI intravesical perfusion,long-term EPI perfusion does not show obvious advantages.The effect of short-term EPI intravesical perfusion in reducing the recurrence and progression of blad-der cancer is equivalent to that of long-term EPI intravesical perfusion,but short-term EPI intravesical perfusion is more reliable in terms of safety for its less frequent and less severe side effects such as gross hematuria and painful urination.Therefore,short-term EPI intravesical perfusion therapy is sufficient at present,but large prospective studies should be conducted in the future to further clarify the best treatment plan for EPI perfusion.

关 键 词：非肌层浸润性膀胱癌 表柔比星 膀胱内化疗 复发 进展 

分 类 号：R737.14[医药卫生—肿瘤]