经导管双侧髂内动脉灌注化疗加栓塞治疗浸润性膀胱癌患者血清肿瘤相关指标水平和5年生存率的影响
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摘要
目的:分析经导管双侧髂内动脉灌注化疗加栓塞治疗肌层浸润性膀胱癌(MIBC)的临床疗效,以及对患者血清肿瘤相关指标水平和5年生存率的影响。方法:对2010年9月-2013年5月期间收治的70例MIBC患者均实施保留膀胱术,根据术后化疗方法不同分为A、B两组:A组36例行经导管双侧髂内动脉灌注化疗加栓塞治疗,B组34例行全身化疗。观察化疗期间不良反应,评估近期疗效,治疗前后采集血清标本检测肿瘤指标水平,并调查随访所有患者5年生存情况。结果:两组不良反应发生率无统计学意义(P>0.05),且均未出现严重不良反应。经秩和检验,A组近期疗效优于B组,两组近期疗效分布比较差异有统计学意义(P<0.05)。两组治疗后血清可溶性细胞间黏附分子-1(sICAM-1)、分泌型蛋白(DKK)、血管内皮生长因子(VEGF)、成纤维细胞生长因子(FGF)水平均较治疗前显著下降,且A组血清sICAM-1、DKK、VEGF、FGF水平下降幅度更显著(P<0.05)。A组患者5年累积生存率为63.88%,略高于B组的52.94%,但差异无统计学意义(P>0.05)。结论:经导管双侧髂内动脉灌注化疗加栓塞可提高MIBC的临床治疗疗效,降低患者血清DKK、VEGF、FGF、MMPs肿瘤相关指标水平,并有望改善预后。
Objective:To analyze the clinical curative effect of transcatheter bilateral internal iliac arterial infusion chemotherapy plus embolization in the treatment of muscular invasive bladder cancer(MIBC),and the influence on levels of serum tumor-related indicators and 5-year survival rate.Methods:Seventy patients with MIBC admitted at our hospital during the period from September 2010 to May 2013 were treated by bladder preserving surgery. They were divided into group A and group B according to different methods for chemotherapy after operation. Thirty-six patients in group A were given transcatheter bilateral internal arterial infusion chemotherapy plus embolization,and 34 patients in group B were subjected to systemic chemotherapy. The adverse reactions during chemotherapy were observed and the short-term curative effect was evaluated. Serum samples were collected before and after treatment to detect the levels of tumor markers,and the 5-year survival of all patients was followed up. Results:There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05),and no serious adverse reactions occurred in both groups. The rank sum test showed that the short-term curative effect in group A was better than that in group B(P<0.05). Levels of serum soluble intercellular adhesion molecule-1(sICAM-1),secreted protein(DKK),vascular endothelial growth factor(VEGF)and fibroblast growth factor(FGF)in both groups were significantly decreased after treatment,and the decrease was greater in group A than in group B(P<0.05). The 5-year cumulative survival rate in group A was slightly higher than that in the group A(63.88% vs. 52.94%,P>0.05).Conclusion:Transcatheter bilateral internal iliac arterial infusion chemotherapy plus embolization can improve the clinical curative effect on MIBC,and decrease the levels of serum tumor markers DKK,VEGF,FGF and MMPs in patients. It is expected to improve the prognosis.
Objective:To analyze the clinical curative effect of transcatheter bilateral internal iliac arterial infusion chemotherapy plus embolization in the treatment of muscular invasive bladder cancer(MIBC),and the influence on levels of serum tumor-related indicators and 5-year survival rate.Methods:Seventy patients with MIBC admitted at our hospital during the period from September 2010 to May 2013 were treated by bladder preserving surgery. They were divided into group A and group B according to different methods for chemotherapy after operation. Thirty-six patients in group A were given transcatheter bilateral internal arterial infusion chemotherapy plus embolization,and 34 patients in group B were subjected to systemic chemotherapy. The adverse reactions during chemotherapy were observed and the short-term curative effect was evaluated. Serum samples were collected before and after treatment to detect the levels of tumor markers,and the 5-year survival of all patients was followed up. Results:There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05),and no serious adverse reactions occurred in both groups. The rank sum test showed that the short-term curative effect in group A was better than that in group B(P<0.05). Levels of serum soluble intercellular adhesion molecule-1(sICAM-1),secreted protein(DKK),vascular endothelial growth factor(VEGF)and fibroblast growth factor(FGF)in both groups were significantly decreased after treatment,and the decrease was greater in group A than in group B(P<0.05). The 5-year cumulative survival rate in group A was slightly higher than that in the group A(63.88% vs. 52.94%,P>0.05).Conclusion:Transcatheter bilateral internal iliac arterial infusion chemotherapy plus embolization can improve the clinical curative effect on MIBC,and decrease the levels of serum tumor markers DKK,VEGF,FGF and MMPs in patients. It is expected to improve the prognosis.
引文
[1]林英立,李艳丽,戚景光,等.血清中CDH13基因启动子甲基化对非肌层浸润性膀胱癌患者术后复发的预测作用.现代泌尿外科杂志,2017,22(8):576-579.
[2]周浴,何敏,贾洪涛,等.经尿道膀胱肿瘤电切术治疗老年肌层浸润性膀胱肿瘤的疗效.海南医学院学报,2016,22(24):3056-3058,3062.
[3]袁润,程帆,张孝斌.肌层浸润性膀胱癌保留膀胱治疗的循证医学进展.现代泌尿生殖肿瘤杂志,2016,8(5):313-316.
[4]杨彬,张雁钢,程伟,等.TURBt联合术前髂内动脉化疗栓塞术治疗大体积肌层浸润性膀胱癌的近期疗效分析.临床泌尿外科杂志,2016(8):710-712.
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[6]代宏.双侧髂内动脉化疗栓塞治疗晚期膀胱癌合并出血的临床分析.血管与腔内血管外科杂志,2017,3(3):766-768.
[7]俞俊杰,周广臣,顾晓,等.髂内动脉化疗栓塞联合经尿道切除治疗肌层浸润性膀胱癌的临床疗效.实用临床医药杂志,2015,19(24):26-28.
[8]HUSSAIN M,THEODORESCU D.Bladder cancer:bladder preservation--learning what we don't know.Nat Rev Urol,2014,11(6):310-312.
[9]EL-GEHANI F,NORTH S,GHOSH S.et al.Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy:A single institution experience.Can Urol Assoc J,2014,8(3/4):E287-E293.
[10]王震霆,罗曼,汪智峰,等.TURBt术前髂内动脉灌注化疗治疗T2,T3期肌层浸润性膀胱癌的疗效及其对患者术后生活质量的影响.海南医学,2017,28(18):2951-2955.
[11]曹明,赵宏,穆鑫,等.吉西他滨联合顺铂方案新辅助化疗联合全膀胱切除术治疗肌层浸润性膀胱癌的9年回顾性分析.中华泌尿外科杂志,2014,35(1):49-53.
[12]张鑫,肖博,陈松,等.吉西他滨与顺铂新辅助化疗治疗肌层浸润性膀胱癌疗效观察.中华实验外科杂志,2015,32(6):1451-1453.
[13]MIYATA Y,NOMATA K,OHBA K,et al.Efficacy and safety of systemic chemotherapy and intraarterial chemotherapy with/without radiotherapy for bladder preservation or as neo-adjuvant therapy in patients with muscle-invasive bladder cancer:A singlecentre study of 163 patients.Eur J Surg Oncol,2015,41(3):361-367.
[14]涂忠,王涛,潘铁军,等.经导管双侧髂内动脉灌注化疗加栓塞治疗浸润性膀胱癌的疗效观察.华南国防医学杂志,2016,30(9):609-610.
[15]黄金明.经尿道膀胱肿瘤切除术联合髂内动脉栓塞化疗治疗高龄高危浸润性膀胱癌的临床效果.中国内镜杂志,2017,23(3):99-103.
[16]王乾,曹敬毅,王淇超,等.肌层浸润性膀胱癌保留膀胱术后髂内动脉灌注化疗的临床疗效.肿瘤防治研究,2015,42(8):810-813.
[17]卢伟,杨超,马军朋,等.经导管动脉化疗栓塞治疗在晚期膀胱癌合并出血中的作用.中国医药导报,2017,14(26):83-85.
[18]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.临床和实验医学杂志,2016,15(17):1692-1695.
[19]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.河北医学,2018,24(1):139-142.
[20]刘卫华,邓红琴,吴振启.保留膀胱术结合髂内动脉灌注化疗治疗肌层浸润性膀胱癌的效果分析.国际泌尿系统杂志,2017,37(1):67-70.
[2]周浴,何敏,贾洪涛,等.经尿道膀胱肿瘤电切术治疗老年肌层浸润性膀胱肿瘤的疗效.海南医学院学报,2016,22(24):3056-3058,3062.
[3]袁润,程帆,张孝斌.肌层浸润性膀胱癌保留膀胱治疗的循证医学进展.现代泌尿生殖肿瘤杂志,2016,8(5):313-316.
[4]杨彬,张雁钢,程伟,等.TURBt联合术前髂内动脉化疗栓塞术治疗大体积肌层浸润性膀胱癌的近期疗效分析.临床泌尿外科杂志,2016(8):710-712.
[5]黄金明.经尿道膀胱肿瘤切除术联合髂内动脉栓塞化疗治疗高龄高危浸润性膀胱癌的临床效果.中国内镜杂志,2017,23(3):99-103.
[6]代宏.双侧髂内动脉化疗栓塞治疗晚期膀胱癌合并出血的临床分析.血管与腔内血管外科杂志,2017,3(3):766-768.
[7]俞俊杰,周广臣,顾晓,等.髂内动脉化疗栓塞联合经尿道切除治疗肌层浸润性膀胱癌的临床疗效.实用临床医药杂志,2015,19(24):26-28.
[8]HUSSAIN M,THEODORESCU D.Bladder cancer:bladder preservation--learning what we don't know.Nat Rev Urol,2014,11(6):310-312.
[9]EL-GEHANI F,NORTH S,GHOSH S.et al.Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy:A single institution experience.Can Urol Assoc J,2014,8(3/4):E287-E293.
[10]王震霆,罗曼,汪智峰,等.TURBt术前髂内动脉灌注化疗治疗T2,T3期肌层浸润性膀胱癌的疗效及其对患者术后生活质量的影响.海南医学,2017,28(18):2951-2955.
[11]曹明,赵宏,穆鑫,等.吉西他滨联合顺铂方案新辅助化疗联合全膀胱切除术治疗肌层浸润性膀胱癌的9年回顾性分析.中华泌尿外科杂志,2014,35(1):49-53.
[12]张鑫,肖博,陈松,等.吉西他滨与顺铂新辅助化疗治疗肌层浸润性膀胱癌疗效观察.中华实验外科杂志,2015,32(6):1451-1453.
[13]MIYATA Y,NOMATA K,OHBA K,et al.Efficacy and safety of systemic chemotherapy and intraarterial chemotherapy with/without radiotherapy for bladder preservation or as neo-adjuvant therapy in patients with muscle-invasive bladder cancer:A singlecentre study of 163 patients.Eur J Surg Oncol,2015,41(3):361-367.
[14]涂忠,王涛,潘铁军,等.经导管双侧髂内动脉灌注化疗加栓塞治疗浸润性膀胱癌的疗效观察.华南国防医学杂志,2016,30(9):609-610.
[15]黄金明.经尿道膀胱肿瘤切除术联合髂内动脉栓塞化疗治疗高龄高危浸润性膀胱癌的临床效果.中国内镜杂志,2017,23(3):99-103.
[16]王乾,曹敬毅,王淇超,等.肌层浸润性膀胱癌保留膀胱术后髂内动脉灌注化疗的临床疗效.肿瘤防治研究,2015,42(8):810-813.
[17]卢伟,杨超,马军朋,等.经导管动脉化疗栓塞治疗在晚期膀胱癌合并出血中的作用.中国医药导报,2017,14(26):83-85.
[18]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.临床和实验医学杂志,2016,15(17):1692-1695.
[19]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.河北医学,2018,24(1):139-142.
[20]刘卫华,邓红琴,吴振启.保留膀胱术结合髂内动脉灌注化疗治疗肌层浸润性膀胱癌的效果分析.国际泌尿系统杂志,2017,37(1):67-70.