新辅助与辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效对比

刘三河; 崔殿生; 贾全安; 邓康俐; 黄雷; 李有元; 魏少忠

doi:10.3971/j.issn.1000-8578.2019.18.1176

新辅助与辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效对比

Effectiveness of Neoadjuvant and Adjuvant Bladder Intracavitary Hyperthermic Perfusion Chemotherapy (BHPC) on High-risk Non-muscle-invasive Bladder Cancer Patients

摘要

摘要:
目的探讨经尿道膀胱肿瘤电切术（TURBT）术前新辅助膀胱热灌注化疗对比术后辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效。
方法收集经尿道膀胱肿瘤电切术术前或术后使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌患者40例，其中16例行术前（吉西他滨1000 mg，45℃，45 min）新辅助膀胱热灌注化疗3次，隔天一次，治疗结束后3~7天行经尿道膀胱肿瘤电切术，定义为新辅助组；另外24例患者先行TURBT手术，术后即刻或者隔天（吉西他滨1000 mg，45℃，45 min）行辅助膀胱热灌注化疗，定义为辅助组。记录并比较两组患者无疾病复发生存期（RFS）以及不良反应。
结果全部40例患者均完成3次吉西他滨膀胱热灌注化疗，新辅助组患者中，完全缓解（pT0）11例（68.8%），部分缓解5例（31.2%）。新辅助组中位无复发生存期为54月，辅助组中位无复发生存期为45月，两者比较差异无统计学意义（P=0.3146）。两组患者不良反应可耐受。
结论无论是新辅助还是辅助治疗，使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌安全有效。

Abstract:
Objective To analyze the effectiveness of neoadjuvant and adjuvant bladder intracavitary hyperthermic perfusion chemotherapy (BHPC) on high-risk non-muscle-invasive bladder cancer (NMIBC) patients.
Methods We included 40 patients with high-risk NMIBC who received BHPC treatment with a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" before or after transurethral resection of the bladder tumor(TURBT). Among these patients, 16 patients received neoadjuvant BHPC treatment (gemcitabine 1000 mg three instillations every other day, 45℃, 45min) before TURBT (neoadjuvant group) and 24 patients received adjuvant BHPC treatment (gemcitabine 1000 mg three instillations every other day, 45℃, 45min) after TURBT (adjuvant group). Disease recurrence free survivals (RFS) and adverse effects were evaluated between both groups.
Results A total of 40 patients completed three times of gemcitabine therapy. In neoadjuvant group, 11 patients (68.8%) showed a complete response (pT0) and 5 patients (32.2%) showed a partial response. The median RFS was 54 months. In adjuvant group, the median RFS was 45 months. The difference of survival rate between them was not statistically significant (P=0.3146). The incidence and severity of side effects were mild in both two groups.
Conclusion BHPC on high-risk NMIBC patients using a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" is safe and effective in both neoadjuvant and adjuvant settings.

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