CAJ | 학술논문

目的探讨经动脉导管化疗联合膀胱灌注化疗在T1G3膀胱癌保留膀胱术后的辅助治疗价值.方法回顾性分析74例接受保留膀胱术的T1G3膀胱尿路上皮癌患者资料,其中经动脉导管化疗联合膀胱灌注化疗组22例(A组)和单纯膀胱灌注化疗组52例(B组),两组患者性别、年龄、肿瘤大小、个数及肿瘤是否初发差异均无统计学意义(P＞0.05).A组患者在保留膀胱术后2～3周接受经动脉化疗,方案为吡柔比星/表柔比星40～60 mg+顺铂60～ 80 mg,间隔4～6周重复1次,每3次为1个疗程；两组患者采用相同膀胱灌注化疗方案.中位随访时间为32个月,统计分析比较两组术后的肿瘤特异病死率、复发率、进展率及复发间隔,同时评价经动脉导管化疗的不良反应.结果 A、B组术后肿瘤特异病死率分别为0％ (0/22)和13.5％ (7/52),差异无统计学意义(P=0.096)；复发率分别为13.6％( 3/22)和46.2％( 24/52),进展率分别为0％( 0/22)和21.2％(11/52),差异均有统计学意义(P=0.000,P=0.048).两组肿瘤中位复发间隔分别为15个月和6.5个月.A组出现轻微恶心、呕吐12例,白细胞下降2例,粒细胞下降2例,肝功能损害4例,肾功能损害1例,所有损害均轻微、可逆. 结论经动脉导管化疗联合膀胱灌注化疗可能有助于T1G3期膀胱癌患者保留膀胱术后预防肿瘤复发、进展和延长患者生存,其不良反应较轻,可用于T1G3期膀胱癌患者保留膀胱术后的辅助治疗.
목적 탐토경동맥도관화료연합방광관주화료재T1G3방광암보류방광술후적보조치료개치.방법 회고성분석74례접수보류방광술적T1G3방광뇨로상피암환자자료,기중경동맥도관화료연합방광관주화료조22례(A조)화단순방광관주화료조52례(B조),량조환자성별、년령、종류대소、개수급종류시부초발차이균무통계학의의(P＞0.05).A조환자재보류방광술후2～3주접수경동맥화료,방안위필유비성/표유비성40～60 mg+순박60～ 80 mg,간격4～6주중복1차,매3차위1개료정；량조환자채용상동방광관주화료방안.중위수방시간위32개월,통계분석비교량조술후적종류특이병사솔、복발솔、진전솔급복발간격,동시평개경동맥도관화료적불량반응.결과 A、B조술후종류특이병사솔분별위0％ (0/22)화13.5％ (7/52),차이무통계학의의(P=0.096)；복발솔분별위13.6％( 3/22)화46.2％( 24/52),진전솔분별위0％( 0/22)화21.2％(11/52),차이균유통계학의의(P=0.000,P=0.048).량조종류중위복발간격분별위15개월화6.5개월.A조출현경미악심、구토12례,백세포하강2례,립세포하강2례,간공능손해4례,신공능손해1례,소유손해균경미、가역. 결론 경동맥도관화료연합방광관주화료가능유조우T1G3기방광암환자보류방광술후예방종류복발、진전화연장환자생존,기불량반응교경,가용우T1G3기방광암환자보류방광술후적보조치료.
Objective To evaluate the clinical effect of post bladder sparing surgery intra-arterial chemotherapy combined with intravesical chemotherapy for the treatment of T1G3 bladder urothelial carcinoma. Methods Seventy-four T1G3 bladder cancer patients were enrolled in this study.After bladder sparing surgery,22 patients received intra-arterial chemotherapy combined with intravesical chemotherapy,while the other 52 patients were treated with intravesical chemotherapy only.There was no significant difference between the 2 groups in sex,age,the size and number of bladder tumor and newly diagnosed cases (P ＞0.05).Twenty-two patients were treated with intra-arterial chemotherapy of piarubicin or epirubicin (40 -60 mg) + cisplatin (60 -80 mg) 2 or 3 weeks after bladder sparing surgery,3 times as a cycle,repeat every 4 - 6 weeks.All the patients received the same protocol of intravesical chemotherapy.With a median follow-up of 32 months,effects of combination therapy group were compared with intravesical chemotherapy group in the aspects of tumor-specific death rates,recurrent rate,progressive rate,recurrent interval and the adverse reactions. Results The tumor-specific death rates of combination therapy group and intravesical chemotherapy group were 0％ (0/22) and 13.5％ (7/52),respectively.There was no difference between the 2 groups (P =0.096).The recurrent rates were 13.6％ (3/22) and 46.2％ ( 24/52 ) ； The progressive rates were 0％ (0/22) and 21.2％ (11/52).There were significant differences between the 2 groups in recurrent rate (P =0.000) and progressive rate (P =0.048 ).The recurrent intervals of the 2 groups were 15 months and 6.5 months.During the interval of intra-arterial chemotherapy cycle,12 patients suffered 1 -2 degree nausea and vomit,2 patients suffered hypoleukemia,2 patients suffered neutropenia,4 patients'liver function was impaired and 1 patient's renal function was impaired.All the adverse reactions were minimal and reversible. Conclusions Intra-arterial chemotherapy combined with intravesical chemotherapy is effective in preventing T1 G3 bladder cancer from recurrence and metastasis after bladder sparing surgery.The adverse reactions of this protocol were minimal and reversible.