Evaluation of different adjunctive therapies after bladder-sparing surgery for muscle-invasive bladder cancer
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摘要: 目的：探索保留膀胱手术+动脉灌注化疗+膀胱内灌注化疗治疗肌层浸润性膀胱癌的临床疗效。方法：对经尿道膀胱肿瘤电切或膀胱部分切除术后确诊为肌层浸润性膀胱癌（T2N0M0）的168例患者均采用保留膀胱治疗方法，分为三个治疗组：综合治疗组68例，术后采用动脉灌注化疗+膀胱灌注化疗；动脉灌注化疗组48例，术后仅采用动脉灌注化疗；膀胱灌注化疗组52例，术后仅采用膀胱灌注化疗。结果：观察期内，综合治疗组患者中92.6%（63/68）无复发及转移，2.9%（2/68）在术后6、13个月出现全身多处转移死亡。动脉灌注化疗组患者中79.2%（38/48）无复发及转移，4.2%（2/48）在术后9、18个月出现全身多处转移死亡。膀胱灌注化疗组患者中44.2%（23/52）无复发及转移，15.4%（8/52）在术后10~96个月转移而死亡。三组疗效按复发率任何两组间比较，差异均有统计学意义（P<0.05）。按癌性死亡率比较，综合治疗组、动脉灌注化疗组分别与膀胱灌注化疗组的差异均有统计学意义（P<0.05）。结论：肌层浸润性膀胱癌（T2N0M0）患者，采用保留膀胱手术+髂内动脉灌注化疗+膀胱内灌注化疗的综合治疗方法，能有效减少肿瘤复发、预防转移、提高患者的生活质量，患者易于接受，值得进一步探讨。Abstract: Objective: To investigate the efficacy of adjunctive therapies after bladder-sparing surgery for muscle-invasive bladder cancer.Method: One hundred and sixty-eight cases diagnosed as muscle-invasive bladder cancer (T2N0M0) after TUR-BT or partial resection of the bladder. They were divided into three groups. The first was combined therapy group which 68 cases received intra-arterial infusion and intravesical infusion chemotherapy after surgery. The second was intra-arterial infusion group which 48 cases underwent intra-arterial infusion after surgery. The third was intravesical infusion chemotherapy group which 52 cases who only use intravesical infusion chemotherapy after surgery.Result: During the observation period 92.6% (63/68) patients of the combined therapy group had no recurrence and metastasis, 2.9% (2/68) patients died of metastasis in six and 13 months after surgery respectively. 79.2% (38/48) patients of intra-arterial infusion chemotherapy group had no recurrence and metastasis, 4.2% (2/48) patients died of systemic metastases in the postoperative nine and 18 months respectively. 44.2% (23/52) patients of intravesical infusion chemotherapy had no recurrence and metastasis, 15.4% (8/52) patients died of metastasis from ten to 96 months after surgery. Relapse rate between any two groups was a statistical different (P<0.05). The data of cancer mortality showed that there was a statistical different (P<0.05) between combined therapy group and intravesical infusion chemotherapy group. The same result could be seen between intra-arterial infusion chemotherapy and intravesical infusion chemotherapy (P<0.05).Conclusion: The combined therapy consisting of bladder-sparing surgery, intra-arterial infusion chemotherapy and intravesical infusion chemotherapy can reduce tumor recurrence, prevent metastases and improve the quality of life for patients with muscle-invasive bladder cancer (T2N0M0). Patients can be easily accepted, so it is worth further investigating.
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