非肌层浸润性膀胱癌术后应用吉西他滨与吡柔比星灌注化疗疗效比较

Comparison of the Efficacy of Postoperative Gemcitabine versus Pirarubicin Perfusion Chemotherapy for Non-Muscle Invasive Bladder Cancer

摘要: 目的：比较非肌层浸润性膀胱癌(NMIBC)行经尿道膀胱肿瘤电切术(TURBT)后应用吉西他滨灌注化疗与应用吡柔比星灌注化疗疗效及不良反应。方法：回顾性分析2014年1月至2017年6月间就诊于胜利油田中心医院泌尿外科的NMIBC患者，所选患者均行TURBT，术后应用吉西他滨灌注化疗的患者设为观察组(72例)，应用吡柔比星灌注化疗的患者设为对照组(70例)。两组患者均于术后24小时内即刻开始膀胱灌注化疗，术后第1周开始持续膀胱灌注化疗，每周1次，持续8周；此后每月1次，持续1年。随访5年时间，观察记录两组患者复发率、进展率以及不良反应情况。采用Kaplan-Meier法比较术后肿瘤无复发和无进展生存时间。结果：本研究共纳入142例NMIBC的患者，随访5年中无死亡病例。观察组与对照组5年的复发率比较差异无统计学意义(P > 0.05)；而观察组术后1年、2年、3年、4年复发率明显低于对照组，差异有统计学意义(P < 0.05)；观察组与对照组5年的进展率比较差异无统计学意义(P > 0.05)；观察组的不良反应明显低于对照组，差异有统计学意义(P < 0.05)。结论：对于NMIBC患者，术后应用吉西他滨灌注化疗治疗相较于应用吡柔比星滨灌注化疗在术后4年内具有更显著的效果，复发率更低，不良反应更少，但是在术后5年两者的复发率差异无统计学意义。

Abstract: Objective: To compare the efficacy and adverse reactions of gemcitabine infusion chemotherapy and pirarubicin infusion chemotherapy after transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC). Methods: The patients with NMIBC who attended the Department of Urology of Shengli Oilfield Central Hospital between January 2014 and June 2017 were retrospectively analyzed, and those who applied gemcitabine infusion chemotherapy after surgery were set as the observation group (72 patients), and those who applied pirarubicin infusion chemotherapy were set as the control group (70 patients). Patients in both groups started bladder perfusion chemotherapy within 24 hours immediately after surgery, and continued bladder perfu-sion chemotherapy once a week for 8 weeks from the first week after surgery, and once a month for 1 year thereafter. The recurrence rate, progression rate and adverse effects were recorded in both groups at a follow-up period of 5 years. The Kaplan-Meier method was used to compare tumor re-currence-free and progression-free survival times after surgery. Results: A total of 142 patients with NMIBC were included in this study, and there were no deaths during the 5-year follow-up. The difference between the 5-year recurrence rate of the observation group and the control group was not statistically significant (P > 0.05); while the recurrence rate of the observation group was signif-icantly lower than that of the control group at 1, 2, 3 and 4 years after surgery, and the difference was statistically significant (P < 0.05); the difference between the 5-year progression rate of the ob-servation group and the control group was not statistically significant (P > 0.05); the adverse reac-tions of the observation group were significantly lower than that of the control group, and the dif-ference was statistically significant (P < 0.05). Conclusions: In patients with NMIBC, postoperative treatment with gemcitabine infusion chemotherapy had a more significant effect with lower recur-rence rates and fewer adverse effects compared with pirarubicin infusion chemotherapy at 4 years postoperatively, but the recurrence rates were not statistically significant at 5 years postoperative-ly.