非肌层浸润性膀胱癌卡介苗治疗复发后增加膀胱内血卟啉灌注光动力治疗预防复发的初步研究结果  

Preliminary results of intravesical hemoporphyrin instillation photodynamic therapy combined with BCG instillation for tumor prevention after non-muscular invasive bladder cancer recurrence treated with BCG vaccine therapy

作　　者：胡林军 白红松 陈永海 谢成明 单兴利 倪冬林 李长岭[2] 李海涛 龙恭伟 刘毅 马金亮 姜焕荣 田军 王东文 HU Linjun;BAI Hongsong;CHEN Yonghai;XIE Chenming;SHAN Xingli;NI Donglin;LI Changling;LI Haitao;LONG Gongwei;LIU Yi;MA Jinliang;JIANG Huanrong;TIAN Jun;WANG Dongwen(Department of Urology,Cancer Hospital of HuanXing Chaoyang District,Beijing 100020,China;不详)

机构地区：[1]北京市朝阳区桓兴肿瘤医院,北京100020 [2]中国医学科学院肿瘤医院 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院

出　　处：《现代泌尿生殖肿瘤杂志》2023年第6期325-329,共5页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：深圳市高水平医院建设专项经费资助;深圳市‘医疗卫生三名工程’项目资助(SZSM202111003)。

摘　　要：目的探索非肌层浸润性膀胱癌(NMIBC)卡介苗(BCG)灌注治疗复发后增加血卟啉膀胱内灌注光动力治疗预防复发的有效性及安全性。方法回顾性分析2016年8月至2021年9月北京市朝阳区桓兴肿瘤医院和中国医院科学院肿瘤医院深圳医院共19例NMIBC行BCG灌注治疗复发且拒绝膀胱全切的患者,其中T1N0M010例,TaN0M08例,T1N0M0/Tis 1例,高级别尿路上皮癌13例,高级别尿路上皮癌合并原位癌1例,低级别尿路上皮癌5例。所有患者先行经尿道膀胱肿瘤切除(TURBT),术后即刻或4周后予以光敏剂血卟啉50 mg+30 ml生理盐水膀胱内灌注并保留60~120 min,再行膀胱内光动力治疗,光照剂量为20 J/cm^(2);TURBT术后2~4周恢复BCG灌注治疗,每3个月复查膀胱镜、CT/MRI和尿细胞学,主要观察指标为1年无复发生存率、1年膀胱保留率和无复发生存时间。结果13例患者无复发状态接受1次光动力治疗,6例无复发状态接受2次治疗。患者的中位随访时间为26.0个月(14.3~77.6个月),共出现5例复发,其中2例患者出现膀胱癌进展转移,1例膀胱癌特异性死亡;1年内无复发生存率为78.9%。1年内膀胱保留率94.7%;中位无复发生存时间(RFS)17个月。在无复发状态连续光动力治疗2次组6个月和12个月无复发生存率均为100%,高于无复发状态单次光动力治疗组6个月(76.9%)和12个月(61.5%)无复发生存率(均P<0.03)。光动力治疗后5例患者出现尿路不适症状(26.3%),主要表现为尿痛、尿频,对症治疗后均缓解,无严重膀胱痉挛及全身光过敏反应发生。结论对BCG灌注治疗失败的NMIBC患者,采用膀胱内灌注血卟啉灌注光动力疗法联合BCG灌注治疗初步显示较好的疗效和安全性,值得进一步研究。Objective To investigate the efficacy and safety of increased intravesical hemoporphyrin instillation with photodynamic therapy after non-muscular invasive bladder cancer(NMIBC)recurrence treated with BCG vaccine in the prevention of postoperative recurrence.Methods A retrospective analysis was performed on 19 patients with NMIBC BCG vaccine instillation recurrence who refused radical cystectomy in Huanxing Cancer Hospital of Chaoyang District,Beijing and Shenzhen Hospital of Cancer Hospital of Chinese Academy of Medical Sciences from August 2016 to September 2021.There were 10 cases of T1N0M0,8 cases of TaN0M0,1 case of T1N0M0/Tis,13 cases of high-grade urothelial carcinoma,1 case of high-grade urothelial carcinoma combined with carcinoma in situ,and 5 cases of low-grade urothelial carcinoma.Transurethral resection of bladder tumour(TURBT)was performed in all patients.Intravesical photosensitizer hemoporphyrin 50 mg+30 ml normal saline instillation were performed for 60-120 minutes immediately or 4 weeks later after TURBT,then intravesical photodynamic therapy with a light dose of 20 J/cm^(2) followed.Intravesical BCG vaccine was continued 2-4 weeks after TURBT.Cystoscopy,CT/MRI and urine cytology were routinely reviewed every 3 months.The primary end point were 1-year recurrence-free survival rate,1-year bladder retention rate and the median recurrence-free survival.Results Thirteen cases received one photodynamic therapy and 6 cases received two photodynamic therapies.The median follow-up time of the patients was 26.0 months(14.3-77.6 months),and a total of 5 patients recurred,including 2 patients with progressive metastasis of bladder cancer and 1 patient with specific death of bladder cancer.The 1-year recurrence-free survival rate was 78.9%.The bladder retention rate within 1 year was 94.7%;The median RFS was 17.0 months.The 6-month and 12-month recurrence-free survival rates of the 2 consecutive photodynamic therapy group during the recurrence-free period were both 100%,which were higher than the 6-month(7

关 键 词：非肌层浸润性膀胱癌 卡介苗治疗治疗复发 膀胱内灌注血卟啉光动力治疗 

分 类 号：R737.14[医药卫生—肿瘤]