不同药物行膀胱内灌注治疗对非肌层浸润性膀胱癌的疗效网状Meta分析  

Efficacy of intravesical perfusion therapy with different drugs on non-muscular invasive bladder cancer:a network Meta-analysis

作　　者：李杨东 范毛川[1] 张少华 孟祥贞 周浩 窦启锋[1] Li Yangdong;Fan Maochuan;Zhang Shaohua;Meng Xiangzhen;Zhou Hao;Dou Qifeng(Department of Urology,the First Clinical College of Xinxiang Medical University,Xinxiang 453199,China)

机构地区：[1]新乡医学院第一附属医院泌尿外科,新乡453199

出　　处：《国际泌尿系统杂志》2024年第1期6-11,共6页International Journal of Urology and Nephrology

基　　金：河南省高等学校重点科研项目(21A320015);新乡市科技攻关项目(GG2020032)。

摘　　要：目的探讨不同药物行膀胱内灌注治疗对非肌层浸润性膀胱癌(NMIBC)的疗效。方法通过计算机系统检索PubMed、SpringerLink、The Cochrane Library、OVID、CNKI、万方、维普数据库中关于不同药物治疗NMIBC的随机对照试验(RCTs), 检索时限为2000年1月1日至2022年3月1日, 文献语言仅限定为中英文。对不同干预措施治疗NMIBC后的肿瘤复发率、膀胱刺激症状、血尿进行网状Meta分析, 通过敏感性分析评价研究结果的稳定性。结果共纳入26篇RCTs, 包含4 403例患者, 涉及6种干预措施:卡介苗(BCG)、表柔比星(EPI)、吉西他滨(GEM)、吡柔比星(THP)、丝裂霉素C(MMC)、羟基喜树碱(HCPT)。网状Meta分析结果显示, 使用BCG者治疗后的1年复发率显著低于使用EPI和MMC者, 差异均有统计学意义(均P<0.05)。1年复发率的累计排序概率图下面积(SUCRA)依次为BCG、THP、GEM、EPI、MMC、HCPT。使用BCG者治疗后的2年复发率均低于使用GEM、EPI、THP、HCPT及MMC者, 而使用GEM者低于使用HCPT, 差异均有统计学意义(均P<0.05)。2年复发率的SUCRA依次为BCG、GEM、EPI、THP、MMC、HCPT。使用GEM者治疗后的膀胱刺激征发生率均低于使用EPI和MMC者, 而使用BCG者治疗后的膀胱刺激征发生率均高于使用GEM、EPI、THP、HCPT, 差异均有统计学意义(均P<0.05)。膀胱刺激征发生率的SUCRA依次为GEM、HCPT、THP、EPI、MMC、BCG。对于6种不同药物治疗NMIBC所引起的血尿发生率比较, 差异均无统计学意义(均P>0.05)。结论 BCG治疗能降低术后NMIBC患者的1、2年复发率, 但并不能降低膀胱刺激征和血尿的发生。GEM治疗在降低1、2年复发率的疗效仅次于BCG, 但能有效预防膀胱刺激征及血尿的发生。Objective To investigate the effect of intravesical infusion with different drugs in the treatment of non-muscular invasive bladder cancer(NMIBC).Methods Randomized controlled trials(RCTs)on NMIBC with different drugs were searched in PubMed,SpringerLink,The Cochrane Library,OVID,CNKI,Wanfang and VIP databases.The search period was from January 1,2000 to March 1,2022,and the literature language was limited to Chinese and English only.A network Metaanalysis was performed on tumor recurrence rate,bladder irritation symptoms,and hematuria after different interventions for NMIBC,and the stability of the findings was evaluated by sensitivity analysis.Results A total of 26 RCTs were included,including 4403 patients,involving 6 interventions:bacille calmette guérin(BCG),epirubicin(EPI),gemcitabine(GEM),pirubicin(THP),mitomycin C(MMC),and hydroxycamptothecin(HCPT).The results of mesh Metaanalysis showed that the 1-year recurrence rate of BCG users was significantly lower than that of EPI and MMC users,with statistical significance(all P<0.05).The surface under the cumulative ranking(SUCRA)of 1-year recurrence rate were BCG,THP,GEM,EPI,MMC and HCPT.The 2-year recurrence rate of BCG patients was lower than that of GEM,EPI,THP,HCPT and MMC patients,while that of GEM patients was lower than that of HCPT patients,the differences were statistically significant(all P<0.05).The SUCRAs with 2-year recurrence rate were BCG,GEM,EPI,THP,MMC and HCPT.The incidence of bladder irritation after treatment in GEM patients was lower than that in EPI and MMC patients,while the incidence of bladder irritation after treatment in BCG patients was higher than that in GEM,EPI,THP and HCPT patients,with statistical significance(all P<0.05).The SUCRA of bladder irritation were GEM,HCPT,THP,EPI,MMC and BCG.There was no significant difference in the incidence of hematuria caused by six different drugs for NMIBC(all P>0.05).Conclusions BCG treatment can reduce the recurrence rate of NMIBC patients after 1 year or 2 years,but can not reduce the occur

关 键 词：膀胱肿瘤 卡介苗 膀胱灌注 膀胱刺激征 血尿 

分 类 号：R737.14[医药卫生—肿瘤]