等离子电切术联合吡柔比星膀胱灌注化疗浅表性膀胱癌的疗效及预后分析
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摘要
目的分析等离子电切术联合吡柔比星膀胱灌注化疗治疗浅表性膀胱癌的疗效与预后。方法选取2014年1月～2018年1月西安医学院第二附属医院收治的浅表性膀胱癌患者87例,按治疗方式分为电切组(等离子电切术)40例与联合组(等离子电切术联合吡柔比星膀胱灌注化疗)47例,比较两组疗效、血清肿瘤标志物及炎症因子、膀胱过度活动症状(OABSS)评分、不良反应发生率及随访1年复发率。结果联合组总缓解率高于电切组(P <0.05);治疗8周后,两组肿瘤标志物[膀胱肿瘤抗原(BTA)、核基蛋白质22(NMP22)、癌胚抗原(CEA)、糖类抗原125(CA125)]及炎症因子[血管内皮生长因子(VEFG)、成纤维细胞生长因子(FGF)]水平均降低,联合组低于电切组(P <0.05);治疗8周后,联合组OABSS各维度评分低于电切组(P <0.05);两组治疗不良反应发生率比较,差异无统计学意义(P> 0.05);随访1年,联合组复发率低于电切组(P <0.05)。结论浅表性膀胱癌患者电切术后早期应用吡柔比星膀胱灌注化疗可提高治疗效果,降低肿瘤标志物及炎症因子水平,改善膀胱过度活动症状,抑制肿瘤复发,且安全性较高。
Objective To analyze the efficacy and prognosis of plasma electrocision combined with pirarubicin intravesical instillation chemotherapy in the treatment of superficial bladder cancer. Methods The clinical data of 87 patients with superficial bladder cancer admitted to hospital from January 2014 to January 2018 were collected. According to the treatment methods,they were divided into electrocision group(plasma electrocision,n=40) and combined group(plasma electrocision combined with pirarubicin intravesical instillation chemotherapy,n=47). The efficacy,serum tumor markers and inflammatory factors,overactive bladder symptom(OABSS) score,incidence rate of adverse reactions and recurrence rate at 1-year of follow-up were compared between the two groups. Results The total remission rate in combined group was higher than that in electrocision group(P < 0.05). Before treatment,there were no significant differences in the levels of tumor markers and inflammatory factors between the two groups(P > 0.05),and the levels of tumor markers [bladder tumor antigen(BTA),nuclear matrix protein 22,22(NMP22),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)] and inflammatory factors [vascular endothelial growth factor(VEFG),fibroblast growth factor(FGF)] were decreased in the two groups after 8 weeks of treatment,and the levels in combined group were lower than those in electrocision group(P < 0.05). Before treatment,there were no significant differences between the two groups in the scores of dimensions of OABSS(P > 0.05),and the scores of dimensions of OABSS in combined group after 8 weeks of treatment were lower than those in electrocision group(P < 0.05). There was no significant difference in the incidence rate of adverse treatment reactions between the two groups(P > 0.05),and the recurrence rate at 1 year of follow-up in combined group was lower than that in electrocision group(P < 0.05). Conclusion Early application of pirarubicin intravesical instillation chemotherapy for patients with superficial bladder cancer after electrocision can improve the treatment effects,reduce the levels of tumor markers and inflammatory factors,improve the symptoms of overactive bladder,and inhibit tumor recurrence,and it has high safety.
Objective To analyze the efficacy and prognosis of plasma electrocision combined with pirarubicin intravesical instillation chemotherapy in the treatment of superficial bladder cancer. Methods The clinical data of 87 patients with superficial bladder cancer admitted to hospital from January 2014 to January 2018 were collected. According to the treatment methods,they were divided into electrocision group(plasma electrocision,n=40) and combined group(plasma electrocision combined with pirarubicin intravesical instillation chemotherapy,n=47). The efficacy,serum tumor markers and inflammatory factors,overactive bladder symptom(OABSS) score,incidence rate of adverse reactions and recurrence rate at 1-year of follow-up were compared between the two groups. Results The total remission rate in combined group was higher than that in electrocision group(P < 0.05). Before treatment,there were no significant differences in the levels of tumor markers and inflammatory factors between the two groups(P > 0.05),and the levels of tumor markers [bladder tumor antigen(BTA),nuclear matrix protein 22,22(NMP22),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)] and inflammatory factors [vascular endothelial growth factor(VEFG),fibroblast growth factor(FGF)] were decreased in the two groups after 8 weeks of treatment,and the levels in combined group were lower than those in electrocision group(P < 0.05). Before treatment,there were no significant differences between the two groups in the scores of dimensions of OABSS(P > 0.05),and the scores of dimensions of OABSS in combined group after 8 weeks of treatment were lower than those in electrocision group(P < 0.05). There was no significant difference in the incidence rate of adverse treatment reactions between the two groups(P > 0.05),and the recurrence rate at 1 year of follow-up in combined group was lower than that in electrocision group(P < 0.05). Conclusion Early application of pirarubicin intravesical instillation chemotherapy for patients with superficial bladder cancer after electrocision can improve the treatment effects,reduce the levels of tumor markers and inflammatory factors,improve the symptoms of overactive bladder,and inhibit tumor recurrence,and it has high safety.
引文
[1]尼加提,董焱鑫,高晓康.非肌层浸润性膀胱癌TURBT术后吡柔比星与丝裂霉素灌注化疗临床效果比较[J].中国医学前沿杂志(电子版),2018,10(11):94-97.
[2]郭学敬,王民,师磊.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[J].中华老年多器官疾病杂志,2018,17(10):762-765.
[3]李文光,吴优.经尿道膀胱肿瘤电切术联合吡柔比星膀胱灌注化疗治疗非肌层浸润性膀胱癌的效果及对钙黏蛋白13甲基化率、Ki-67高表达率的影响[J].中国老年学杂志,2018,38(16):3885-3887.
[4]Freeman JA,Esrig D,Stein JP,et al.Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction[J].Cancer,2015,76(5):833-839.
[5]Wagner U,Süess K,Luginbühl T,et al.Cyclin D1 overexpression lacks prognostic significance in superficial urinary bladder cancer[J].J Pathol,2015,188(1):44-50.
[6]邱志磊,牛海涛,孙光.2005年欧洲泌尿外科会议膀胱癌诊断治疗纲要[J].临床泌尿外科杂志,2006,21(4):318-320.
[7]许克新,汪磊,王晓峰,等.膀胱过度活动症症状评分表对中国OAB患者结果评估的重复信度及与其他症状评分工具间相关性的研究[J].中华泌尿外科杂志,2010,31(11):727-731.
[8]王哲,张敬,孙祖刚,等.吡柔比星膀胱灌注化疗对浅表性膀胱癌术后患者血清相关因子的影响[J].河北医学,2018,24(1):139-142.
[9]Tosoni I,Wagner U,Sauter G,et al.Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer[J].Bju Int,2015,85(1):48-53.
[10]郭学敬,王民,师磊,等.老年浅表性膀胱癌病人尿道膀胱肿瘤电切术后即刻吡柔比星热灌注与常规灌注的临床观察[J].实用老年医学,2018,32(6):524-526.
[11]Shelley MD,Wilt TJ,Court J,et al.Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer:a metaanalysis of randomized trials[J].Bju Int,2015,93(4):485-490.
[12]白大应,刘杰,王云杰,等.二次电切联合吡柔比星即刻灌注治疗非肌层浸润性膀胱癌临床疗效观察[J].微创泌尿外科杂志,2018,7(1):61-64.
[13]Hinotsu S,Akaza H,Ohashi Y,et al.Intravesical chemotherapy for maximum prophylaxis of new early phase superficial bladder carcinoma treated by transurethral resection[J].Cancer,2015,86(9):1818-1826.
[14]张国平,雷弋,王岭,等.吉西他滨膀胱灌注治疗非肌层浸润性膀胱癌的疗效及安全性分析[J].四川医学,2018,39(11):1246-1249.
[15]杨清荣,马莉,但丹,等.绿激光汽化术与膀胱癌电切术联合吡柔比星灌注化疗的队列研究[J].西部医学,2016,28(2):181-184.
[16]Yoshioka H,Shimbo T,Yoshida K,et al.Treatment results of radiotherapy combined with balloon-occluded arterial infusion chemotherapy for invasive bladder cancer[J].Anticancer Res,2016,36(2):731-736.
[17]Danesi DT,Arcangeli G,Cruciani E,et al.Combined treatment of invasive bladder carcinoma with transurethral resection,induction chemotherapy,and radical radiotherapy plus concomitant protracted infusion of cisplatin and 5-fluorouracil:a phase I study[J].Cancer,2015,80(8):1464-1471.
[18]Azuma H,Inamoto T,Takahara K,et al.The novel bladder preservation therapy BOAI-CDDP-radiation(OMC-regimen):a new treatment option for invasive bladder cancer patients with lymph node metastasis[J].Int J Oncol,2014,44(6):1895-1903.
[19]全艺.吡柔比星膀胱灌注治疗对TURBT膀胱癌术后复发及血清肿瘤活力指标的影响[J].临床和实验医学杂志,2016,15(17):1692-1695.
[2]郭学敬,王民,师磊.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[J].中华老年多器官疾病杂志,2018,17(10):762-765.
[3]李文光,吴优.经尿道膀胱肿瘤电切术联合吡柔比星膀胱灌注化疗治疗非肌层浸润性膀胱癌的效果及对钙黏蛋白13甲基化率、Ki-67高表达率的影响[J].中国老年学杂志,2018,38(16):3885-3887.
[4]Freeman JA,Esrig D,Stein JP,et al.Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction[J].Cancer,2015,76(5):833-839.
[5]Wagner U,Süess K,Luginbühl T,et al.Cyclin D1 overexpression lacks prognostic significance in superficial urinary bladder cancer[J].J Pathol,2015,188(1):44-50.
[6]邱志磊,牛海涛,孙光.2005年欧洲泌尿外科会议膀胱癌诊断治疗纲要[J].临床泌尿外科杂志,2006,21(4):318-320.
[7]许克新,汪磊,王晓峰,等.膀胱过度活动症症状评分表对中国OAB患者结果评估的重复信度及与其他症状评分工具间相关性的研究[J].中华泌尿外科杂志,2010,31(11):727-731.
[8]王哲,张敬,孙祖刚,等.吡柔比星膀胱灌注化疗对浅表性膀胱癌术后患者血清相关因子的影响[J].河北医学,2018,24(1):139-142.
[9]Tosoni I,Wagner U,Sauter G,et al.Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer[J].Bju Int,2015,85(1):48-53.
[10]郭学敬,王民,师磊,等.老年浅表性膀胱癌病人尿道膀胱肿瘤电切术后即刻吡柔比星热灌注与常规灌注的临床观察[J].实用老年医学,2018,32(6):524-526.
[11]Shelley MD,Wilt TJ,Court J,et al.Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer:a metaanalysis of randomized trials[J].Bju Int,2015,93(4):485-490.
[12]白大应,刘杰,王云杰,等.二次电切联合吡柔比星即刻灌注治疗非肌层浸润性膀胱癌临床疗效观察[J].微创泌尿外科杂志,2018,7(1):61-64.
[13]Hinotsu S,Akaza H,Ohashi Y,et al.Intravesical chemotherapy for maximum prophylaxis of new early phase superficial bladder carcinoma treated by transurethral resection[J].Cancer,2015,86(9):1818-1826.
[14]张国平,雷弋,王岭,等.吉西他滨膀胱灌注治疗非肌层浸润性膀胱癌的疗效及安全性分析[J].四川医学,2018,39(11):1246-1249.
[15]杨清荣,马莉,但丹,等.绿激光汽化术与膀胱癌电切术联合吡柔比星灌注化疗的队列研究[J].西部医学,2016,28(2):181-184.
[16]Yoshioka H,Shimbo T,Yoshida K,et al.Treatment results of radiotherapy combined with balloon-occluded arterial infusion chemotherapy for invasive bladder cancer[J].Anticancer Res,2016,36(2):731-736.
[17]Danesi DT,Arcangeli G,Cruciani E,et al.Combined treatment of invasive bladder carcinoma with transurethral resection,induction chemotherapy,and radical radiotherapy plus concomitant protracted infusion of cisplatin and 5-fluorouracil:a phase I study[J].Cancer,2015,80(8):1464-1471.
[18]Azuma H,Inamoto T,Takahara K,et al.The novel bladder preservation therapy BOAI-CDDP-radiation(OMC-regimen):a new treatment option for invasive bladder cancer patients with lymph node metastasis[J].Int J Oncol,2014,44(6):1895-1903.
[19]全艺.吡柔比星膀胱灌注治疗对TURBT膀胱癌术后复发及血清肿瘤活力指标的影响[J].临床和实验医学杂志,2016,15(17):1692-1695.