单次灌注化疗后膀胱持续生理盐水冲洗或增加中低风险非肌层浸润性膀胱癌进展风险  

Continuous saline bladder irrigation after a single instillation of chemotherapy increases the risk of progression of low-and immediate-risk non-muscle-invasive bladder cancer

作　　者：王飞[1] 杜依青 秦彩朋[1] 李清[1] 刘士军[1] 徐涛[1] WANG Fei;DU Yiqing;QIN Caipeng;LI Qing;LIU Shijun;XU Tao(Department of Urology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《现代泌尿外科杂志》2024年第6期481-485,共5页Journal of Modern Urology

基　　金：国家重点研发计划项目(No.2018YFA0902802);国家自然科学基金项目(No.82271877);北京市科学技术委员会项目(No.Z221100007422058);北京大学人民医院研究与发展基金资助课题项目(No.RDGS2022-02)。

摘　　要：目的探究行经尿道膀胱肿瘤切除术(TURBT)的中低风险非肌层浸润性膀胱癌(NMIBC)患者单次即刻膀胱灌注化疗(SIIC)后膀胱持续生理盐水冲洗(CSBI)的治疗效果。方法回顾性分析2004年1月—2019年12月于北京大学人民医院泌尿外科行TURBT的211例中低风险NMIBC患者的临床资料,根据患者SIIC后是否进行CSBI分为CSBI组和无CSBI组,比较两组患者的复发率、进展率、无复发生存率和无进展生存率。通过Cox单因素及多因素回归分析探究CSBI是否为患者肿瘤复发和进展的危险因素。结果两组患者的基线资料、复发率和进展率比较,差异均无统计学意义(P>0.05)。两组患者无复发生存率比较无明显差异,而CSBI组无进展生存率更低(χ^(2)=8.270,P=0.004)。在多因素Cox回归分析中,糖尿病(HR:2.240,95%CI:1.066~4.704,P=0.033)和多发肿瘤(HR:3.060,95%CI:1.639~5.711,P<0.001)是中低风险NMIBC患者肿瘤复发的独立危险因素,CSBI(HR:7.914,95%CI:1.710~36.632,P=0.008)是肿瘤进展的独立危险因素。结论SIIC后CSBI可能会增加中低风险NMIBC患者的进展风险,但该结论仍需要更大样本量进行验证。Objective To investigate the efficacy of continuous saline bladder irrigation(CSBI)after a single immediate instillation of chemotherapy(SIIC)in patients with low-and immediate-risk non-muscle-invasive bladder cancer(NMIBC)undergoing transurethral resection of bladder tumor(TURBT).Methods Clinical data of 211 patients with with low-and immediate-risk NMIBC,who underwent TURBT in our hospital during Jan.2004 and Dec.2019 were collected.The patients were divided into two groups according to whether CSBI was conducted after SIIC.The recurrence rate,progression rate,recurrence-free survival and progression-free survival of the two groups were compared.Cox univariate and multivariate regression analyses were used to investigate whether CSBI was a risk factor for recurrence and progression.Results There were no significant differences in baseline data,recurrence rate and progression rate between the two groups(P>0.05).There was no significant difference in recurrence-free survival between the two groups,but the progression-free survival was shorter in CSBI group(χ^(2)=8.270,P=0.004).Multivariate Cox regression analysis indicated that diabetes(HR:2.240,95%CI:1.066-4.704,P=0.033)and multiple tumors(HR:3.060,95%CI:1.639-5.711,P<0.001)were independent risk factors for recurrence and CSBI(HR:7.914,95%CI:1.710-36.632,P=0.008)was an independent risk factor for progression.Conclusion CSBI after SIIC may increase the risk of progression in patients with low-and immediate-risk NMIBC,but a larger sample size is needed for validation.

关 键 词：膀胱癌 单次即刻膀胱灌注化疗 膀胱持续生理盐水冲洗 膀胱内复发 肿瘤进展 

分 类 号：R737.14[医药卫生—肿瘤]