CAJ | 학술논문

目的：评价吉西他滨膀胱灌注化疗治疗常规膀胱灌注化疗失败的非肌层浸润性膀胱癌（NMIBC）的有效性及耐受性。方法采用随机数表法将48例持续常规膀胱灌注化疗1年内出现肿瘤复发的NMIBC患者均分为A、B、C三组，每组各16例。A组患者给予1000 mg吉西他滨灌洗， B组患者给予2000 mg吉西他滨灌洗，C组患者则继续采用原化疗方案灌洗。分析三组患者2年肿瘤复发率、复发进展率及不良反应发生情况。结果 A、B组患者2年肿瘤无复发生存率（68.75%，75.00%）明显高于C组（18.75%），通过log-rank test检验，A、B组与C组比较差异具有显著性（P＜0.05），但A组与B组差异无显著性（χ2＝0.246，P＝0.620）。三组患者2年肿瘤复发进展率分别为25.00%、18.75%、25.00％，组间比较差异无显著性（χ2＝0.253，P＝0.881）。三组患者不良反应发生率分别为31.25%、25.00%、37.50%，组间比较差异无显著性（χ2＝0.582，P＝0.748）。不良反应主要表现为尿频、尿急、尿痛等，经对症治疗后缓解，未发生严重的血液学不良反应。结论吉西他滨膀胱灌注化疗对常规膀胱灌注化疗后复发的NMIBC疗效显著，降低高危NMIBC复发率，但对膀胱肿瘤进展无明显预防作用，且不同剂量间的疗效未见明显差异。
목적：평개길서타빈방광관주화료치료상규방광관주화료실패적비기층침윤성방광암（NMIBC）적유효성급내수성。방법채용수궤수표법장48례지속상규방광관주화료1년내출현종류복발적NMIBC환자균분위A、B、C삼조，매조각16례。A조환자급여1000 mg길서타빈관세， B조환자급여2000 mg길서타빈관세，C조환자칙계속채용원화료방안관세。분석삼조환자2년종류복발솔、복발진전솔급불량반응발생정황。결과 A、B조환자2년종류무복발생존솔（68.75%，75.00%）명현고우C조（18.75%），통과log-rank test검험，A、B조여C조비교차이구유현저성（P＜0.05），단A조여B조차이무현저성（χ2＝0.246，P＝0.620）。삼조환자2년종류복발진전솔분별위25.00%、18.75%、25.00％，조간비교차이무현저성（χ2＝0.253，P＝0.881）。삼조환자불량반응발생솔분별위31.25%、25.00%、37.50%，조간비교차이무현저성（χ2＝0.582，P＝0.748）。불량반응주요표현위뇨빈、뇨급、뇨통등，경대증치료후완해，미발생엄중적혈액학불량반응。결론길서타빈방광관주화료대상규방광관주화료후복발적NMIBC료효현저，강저고위NMIBC복발솔，단대방광종류진전무명현예방작용，차불동제량간적료효미견명현차이。
ObjectiveTo evaluate the efficacy and tolerability of intravesical gemcitabine after first-line in travesical chemotherapy failure in the treatment of non-muscle-invasive bladdercancer (NMIBC).Method 48 patients with NMIBC, who had tumor recurrence within one year of ifrst-line intravesical chemotherapy, were assigned to 3 groups (16 cases in each group). Group A received intravesical gemcitabine in a dose of 1000 mg, group B received 2000 mg gemcitabine, and group C received original intravesical chemotherapy. Analyzed three groups of patients 2 years tunor recurrence rates, incidence of recurrence rate and adverse reaction.ResultGroup A and B of 2 years tumor free survival (68.75%, 75.00%) were higher than that in group C (18.75%), by log-rank-test tested between group A, B and group C were statistically signiifcant differences (P<0.05), but group A and group B had no signiifcant difference (χ2=0.246,P=0.620). Three groups of 2 year recurrence progression rates were 25.00%, 18.75%, 25.00%, and no signiifcant difference between three groups (χ2=0.253, P=0.881). Three groups of adverse reaction rate were 31.25%, 25.00%, 37.50%, there was no statistical difference between groups (χ2=0.582, P=0.748). Adverse reactions among three groups weres urinary frequency, urgency, dysuria, hematuria, relieved by symptomatic treatment, no serious haematological adverse reactions.ConclusionIntravesical chemotherapy with gemcitabine is well tolerated and effective for patients with high risk NMIBC, however, which treatment dose not reduce tumor progress, and the effect of different dose have no signiifcant difference.