| 王守磊,吉振帅,谢 程,张鹏程,蔡成宽,支运来,张志刚,王鲲鹏,孙方浒.非肌层浸润性膀胱癌患者TURBT术后吉西他滨与表柔比星膀胱灌注化疗的疗效比较及复发的危险因素分析[J].,2022,(18):3499-3503 |
| 非肌层浸润性膀胱癌患者TURBT术后吉西他滨与表柔比星膀胱灌注化疗的疗效比较及复发的危险因素分析 |
| Comparison of the Efficacy of Gemcitabine and Epirubicin Intravesical Chemotherapy in Patients with Non Muscle Invasive Bladder Cancer after TURBT and Analysis of Risk Factors for Recurrence |
| 投稿时间：2022-03-03 修订日期：2022-03-28 |
| DOI：10.13241/j.cnki.pmb.2022.18.018 |
| 中文关键词: 非肌层浸润性膀胱癌 经尿道膀胱肿瘤电切术 吉西他滨 表柔比星 膀胱灌注化疗 疗效 复发 危险因素 |
| 英文关键词: Non muscle invasive bladder cancer Transurethral resection of bladder tumor Gemcitabine Epirubicin Intravesical chemotherapy Efficacy Recurrence Risk Factor |
| 基金项目:江苏省自然科学基金项目（BK2016132）；连云港市社会发展计划项目（SH1405） |
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| 中文摘要: |
| 摘要 目的：对比非肌层浸润性膀胱癌（NMIBC）患者经尿道膀胱肿瘤电切术（TURBT）后吉西他滨与表柔比星膀胱灌注化疗的临床疗效，并分析复发的危险因素。方法：纳入徐州医科大学附属连云港医院2018年1月至2020年1月期间接收的NMIBC患者120例，均接受TURBT治疗。根据化疗用药方式的不同将120例NMIBC患者分为表柔比星组（n=58，表柔比星治疗）和吉西他滨组（n=62，吉西他滨治疗），对比表柔比星组、吉西他滨组的免疫功能、肿瘤标志物变化，观察不良反应发生率及1年复发情况。采用多因素Logistic回归分析NMIBC患者行TURBT后复发的危险因素。结果：表柔比星组、吉西他滨组治疗后CD3+、CD4+、CD4+/CD8+升高，且吉西他滨组高于表柔比星组（P<0.05）；CD8+下降，且吉西他滨组低于表柔比星组（P<0.05）。表柔比星组、吉西他滨组治疗后癌胚抗原（CEA）、细胞角蛋白19（CK19）和癌抗原199（CA199）均下降，且吉西他滨组低于表柔比星组（P<0.05）。表柔比星组、吉西他滨组不良反应发生率对比未见统计学差异（P>0.05）。表柔比星组、吉西他滨组1年复发率对比未见统计学差异（P>0.05）。将表柔比星组、吉西他滨组1年后复发的患者总和28例纳为复发组，其余未复发的92例纳为未复发组。单因素分析结果显示：NMIBC患者行TURBT后复发与肿瘤数目、最大肿瘤直径、肿瘤分化分级、临床分期有关（P<0.05）。多因素Logistic回归分析结果显示：肿瘤数目为多发、最大肿瘤直径≧5 cm、肿瘤分化分级为低分化、临床分期为T1期为NMIBC患者行TURBT后复发的危险因素（P<0.05）。结论：与表柔比星化疗相比，吉西他滨化疗可更好的控制肿瘤疾病进展，有效保护机体免疫功能，两种化疗药物下安全性和复发率相接近。同时研究还观察到，复发受到多种因素影响，包括肿瘤数目、最大肿瘤直径、肿瘤分化分级、临床分期。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the clinical efficacy of gemcitabine and epirubicin intravesical chemotherapy in patients with non muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT) and analyze the risk factors for recurrence. Methods: 120 patients with NMIBC who were received in Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2018 to January 2020 were included and all received TURBT treatment. According to the different ways of chemotherapy, 120 patients with NMIBC were divided into epirubicin group (n=58, epirubicin treatment) and gemcitabine group (n=62, gemcitabine treatment). The changes of immune function and tumor markers in epirubicin group and gemcitabine group were compared, and the incidence of adverse reactions and 1-year recurrence were observed. Multivariate logistic regression was used to analyze the risk factors of recurrence in patients with NMIBC after TURBT. Results: After treatment, the levels of CD3+, CD4+, CD4+/CD8+ in epirubicin group and gemcitabine group were increased, and the gemcitabine group were higher than those in epirubicin group(P<0.05). CD8+ decreased, and gemcitabine group was lower than epirubicin group(P<0.05). After treatment, carcinoembryonic antigen (CEA), cytokeratin 19 (CK19) and cancer antigen 199 (CA199) in epirubicin group and gemcitabine group decreased, and gemcitabine group was lower than that in epirubicin group (P<0.05). There was no significant difference in the incidence of adverse reactions between epirubicin group and gemcitabine group (P>0.05). There was no significant difference in the 1-year recurrence rate between epirubicin group and gemcitabine group (P>0.05). 28 patients in epirubicin group and gemcitabine group who recurred after one year were included in the recurrence group, and the other 92 patients who did not recur were included in the non recurrence group. Univariate analysis showed that the recurrence of NMIBC patients after TURBT was related to the number of tumors, maximum tumor diameter, tumor differentiation grade and clinical stage(P<0.05). Multivariate logistic regression analysis showed that the number of tumors was multiple, the maximum tumor diameter ≥5 cm, the tumor differentiation grade was poorly differentiated, and the clinical stage was T1 stage, which were the risk factors of recurrence in patients with NMIBC after TURBT(P<0.05). Conclusion: Compared with epirubicin chemotherapy, gemcitabine chemotherapy can better control the progression of tumor diseases and effectively protect the immune function. The safety and recurrence rate of the two chemotherapy drugs are similar. At the same time, the study also observed that recurrence was affected by many factors, including tumor number, maximum tumor diameter, tumor differentiation and grade, and clinical stage. |
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