新辅助化疗联合经尿道绿激光汽化术治疗肌层浸润性膀胱癌的临床疗效观察

张志华; 李健; 王亚申

doi:10.13201/j.issn.1001-1420.2017.06.012

新辅助化疗联合经尿道绿激光汽化术治疗肌层浸润性膀胱癌的临床疗效观察

- 天津市人民医院泌尿外科(天津, 300121)

详细信息

通讯作者: 李健,E-mail:lijian_umc@sina.com

中图分类号: R737.14

收稿日期: 2016-10-10

Clinical observation of neoadjuvant chemotherapycombined with radical transurethral photoselective vaporization of bladder tumours in treating muscle invasive bladder cancer

- Department of Urology, Tianjin People's Hospital, Tianjin, 300121, China

More Information

Corresponding author: LI Jian, E-mail: lijian_umc@sina.com

Received Date: 10 October 2016

摘要

摘要: 目的:观察应用新辅助化疗(NAC)联合根治性经尿道膀胱肿瘤绿激光汽化术(RPVBT)治疗肌层浸润性膀胱癌(MIBC)的疗效和安全性。方法:2012年10月²014年10月收治因无法耐受或不愿接受根治性膀胱切除术的MIBC患者,排除不适合化疗者,共41例接受NAC联合RPVBT治疗。年龄46~82岁,平均61岁;肿瘤最大经线1.5~4.5cm,平均3.2cm。术前病理诊断为尿路上皮癌,临床分期为T₂~T_3a。采用吉西他滨+顺铂(GC方案)全身化疗2~3个疗程后行RPVBT,切除深度至膀胱外脂肪层,范围至肿瘤周围2cm。术后定期随访。结果:41例患者共接受116个疗程NAC,平均2.83个疗程。化疗后肿瘤最大径线1.5~4.0cm,平均2.4cm,较化疗前缩小(P<0.05);肿瘤临床分期降期者26例(63.41%);肿瘤数目较前减少者11例(26.83%);28例(68.29%)出现不同程度药物毒性反应。41例手术均顺利完成,手术时间12~75min,平均42.2min,无严重并发症。术后随访12~36个月,平均21个月。复发10例(24.39%),死亡1例。结论:NAC联合RPVBT治疗MIBC具有一定疗效,是不能耐受或不愿意接受根治性膀胱切除术患者可以选择的治疗策略。
- 肌层浸润性膀胱癌 /
- 新辅助化疗 /
- 绿激光
Abstract: Objective:To observe the safety and clinical efficacy of neoadjuvant chemotherapy (NAC) combined with radical transurethral photoselective vaporization of bladder tumours (RPVBT) in the treatment of muscle invasive bladder cancer (MIBC). Method:During Oct.2012 to Oct.2014, there were 41 patients with MIBC (T₂ ~T_3a) , with a mean age of 61 (range, 46-82) years old.They were unable to tolerate or unwilling to receive radical cystectomy.The maximum diameter of tumor ranged from 1.5to 4.5cm, 3.2cm on the average.These patients were treated by RPVBT after 2-3cycles of NAC (gemcitabine/cisplatin). The operative procedure, the first recurrence duration, the recurrence rate and the survival rate were measured.Result:A total of 116 cycles of chemotherapy had been done.After NAC, the maximum diameter of 1.5-4.0 (average, 2.4) cm reduced compared to that before NAC (P<0.05). There was tumor down-staging in 26 of the total patients (63.41%). The mumber of tumors decreased in 11cases (26.83%). The toxicity of drug was seen in 28cases (68.29%). The operative procedure ranged from 12-75 (average, 42.2) min, and no postoperative complication was found.Over 12-36 (average, 21) months of follow-up period, 10cases (24.39%) recurred.The first recurrence duration ranged from 6to 24 months after operation and one patient died.Conclusion:The treatment of NAC combined with RPVBT in MIBC has certain curative effect.It could be an effective treatment for patients who are unable or unwilling to accept radical cystectomy.
- muscle invasive bladder cancer /
- neoadjuvant chemotherapy /
- green laser

HTML全文

参考文献(15)

[1]	Bolenz C, Ho R, Nuss G R, et al.Management of elderly patients with urothelial carcinoma of the bladder:guideline concordance and predictors of overall survival[J].BJU Int, 2010, 106 (9):1324-1329.
[2]	Gilbert S M, Wood D P, Dunn R L, et al.Measuring health-related quality of life outcomes in bladder cancer patients using the Bladder Cancer Index (BCI)[J].Cancer, 2007, 109 (9):1756-1762.
[3]	Shipley W U, Kaufman D S, Zehr E, et al.Selective bladder preservation by combined modality protocol treatment:long-term outcomes of 190patients with invasive bladder cancer[J].Urology, 2002, 60 (1):62-67, 67-68.
[4]	Efstathiou J A, Spiegel D Y, Shipley W U, et al.Long-term outcomes of selective bladder preservation by combinedmodality therapy for invasive bladder cancer:the MGH experience[J].Eur Urol, 2012, 61 (4):705-711.
[5]	Mak R H, Hunt D, Shipley W U, et al.Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy:apooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and0233[J].J Clin Oncol, 2014, 32 (34):3801-3809.
[6]	李昭夷, 侯瑞鹏, 李健.根治性经尿道绿激光汽化术联合化疗治疗肌层浸润性膀胱癌的临床观察[J].中华泌尿外科杂志, 2015, 36 (7):487-489.
[7]	Koie T, Ohyama C, Yamamoto H, et al.Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T₂bladder cancer[J].Med Oncol, 2014, 31 (5):949.
[8]	李双辉, 张志宏, 徐勇, 等.根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析[J].中华泌尿外科杂志, 2012, 33 (3):215-218.
[9]	李涛, 傅崇德, 付生军, 等.新辅助化疗联合根治性手术治疗肌层浸润性膀胱癌临床预后的系统评价[J].中华临床医师杂志 (电子版), 2015 (19):3604-3611.
[10]	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[J].中华泌尿外科杂志, 2014, 35 (1):49-53.
[11]	卢素琼, 赵化荣, 胡尔西旦, 等.局部肌层浸润性膀胱癌预后影响因素分析[J].中国肿瘤临床, 2012, 39 (9):593
[12]	von der Maase H, Sengelov L, Roberts J T, et al.Longterm survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer[J].J Clin Oncol, 2005, 23 (21):4602-4608.
[13]	Arcangeli G, Arcangeli S, Strigari L.A systematic review and meta-analysis of clinical trials of bladder-sparing trimodality treatment for muscle-invasive bladder cancer (MIBC)[J].Crit Rev Oncol Hematol, 2015, 94 (1):105-115.
[14]	李健, 侯瑞鹏, 张志华, 等.经尿道绿激光汽化和经尿道电切治疗经尿道电切治疗浅表性膀胱肿瘤的疗效比较[J].临床泌尿外科杂志, 2010, 25 (8):586-588.
[15]	Oosterlinck W, Kurth K H, Schroder F, et al.A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage T_a, T₁ papillary carcinoma of the bladder[J].J Urol, 1993, 149 (4):749-752.