老年浅表性膀胱癌患者经尿道膀胱肿瘤电切术后吉西他滨与吡柔比星膀胱热灌注的临床观察

Clinical observation of intravesical hyperthermic perfusion with gemcitabine and pirarubicin in the elderly with superficial bladder cancer after transurethral resection of bladder tumor

摘要:

目的 探究经尿道膀胱肿瘤电切术(TURBT)后吉西他滨与吡柔比星膀胱热灌注化疗对老年浅表性膀胱癌患者的疗效和安全性。方法 回顾性分析2012年4月至2015年4月在北京老年医院泌尿外科行TURBT治疗的老年浅表性膀胱癌患者90例,根据膀胱热灌注化疗药物不同分为吉西他滨组和吡柔比星组,每组45例。吉西他滨组患者1000 mg吉西他滨加入到0.9%氯化钠溶液500 ml软包装中加热至50℃,吡柔比星组患者40 mg吡柔比星加入到5%葡萄糖溶液500 ml软包装中加热至50℃,2组患者术后6 h内都以300 ml/min流量模式进行循环灌注,治疗1 h,以后每周以同样方法膀胱热灌注1次,共8次。然后每月1次,持续1年。随访比较2组患者的肿瘤复发率、无复发生存时间和不良反应发生情况。应用SPSS 17.0统计软件对数据进行分析。组间比较采用t检验或χ²检验。无复发生存时间采用Kaplan-Meier生存曲线,比较用Log-rank检验。结果 全部病例随访12～36个月,2组患者12个月[8.89%(4/45) vs 15.56%(7/45),P=0.334]和36个月复发率[15.56%(7/45) vs 28.89%(13/45),P=0.128]差异无统计学意义。吉西他滨组患者相比吡柔比星组患者的无复发生存时间长[(32.99±1.53) vs(27.71±1.95)个月,P=0.047],总不良反应发生率低[42.2%(19/45) vs 97.8%(44/45),P＜0.05]。吉西他滨组患者血尿、尿痛、膀胱炎发生率与吡柔比星组患者差异具有统计学意义(P＜0.05)。结论 TURBT后吉西他滨膀胱热灌注化疗疗效满意,不良反应轻,是预防老年浅表性膀胱癌患者术后复发的有效方法。

Abstract:

Objective To investigate the efficacy and safety of intravesical hyperthermic perfusion with gemcitabine and pirarubicin in the elderly patients with superficial bladder cancer after transurethral resection of bladder tumor (TURBT). Methods A retrospective analysis was made of 90 elderly patients with superficial bladder cancer treated with TURBT in the Department of Urology Surgery of Beijing Geriatric Hospital from April 2012 to April 2015. They were divided into gemcitabine group and pirarubicin group, with 45 in each group. In the former, a plastic bag of 500 ml sodium chloride solution (0.9%) added with 1000 mg gemcitabine was heated to 50℃. In the latter, a plastic bag of 500 ml glucose solution (5%) added with 40 mg pirarubicin was heated to 50℃. All the patients were perfused at 300 ml/min within 6 hours after operation for 1 hour, then once a week for 8 times, and once a month for one year. The 2 groups were compared in the recurrence rate, recurrence-free survival time and adverse reactions. SPSS statistics 17.0 was used for data analysis, and Student′s t test or Chi-square test for comparison between groups. Kaplan-Meier survival curves were made for survival time without recurrence and Log-rank test was performed for comparison. Results All patients were followed up for 12-36 months. No significant differences were observed between the 2 group in recurrence rate at 12 months [8.89%(4/45) vs 15.56%(7/45), P=0.334] and at 36 months [15.56%(7/45) vs 28.89%(13/45), P=0.128]. Compared with pirarubicin group, the gemcitabine group had longer recurrence-free survival time [(32.99±1.53) vs (27.71±1.95) months] and lower incidence of total adverse reactions [42.2%(19/45) vs 97.8%(44/45), P<0. 05]. Statistically significant differences were observed between the 2 groups in the incidence of hematuria, urinary pain and cystitis (P<0.05). Conclusion Intravesical hyperthermic perfusion of gemcitabine after TURBT has satisfactory efficacy with mild adverse reactions, serving as an effective way to prevent postoperative recurrence in the elderly patients with superficial bladder cancer.