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1.
目的 用Meta分析比较吡柔比星(THP)、丝裂霉素C(MMC)膀胱灌注预防膀胱癌术后复发的疗效观察与毒性。方法 检索国内外已公开发表的关于THP与MMC膀胱灌注治疗人膀胱癌复发的比较性研究资料,对纳入研究的资料进行统计学综合(Meta分析)。结果共有8项研究符合标准被纳入,涉及总病例数629例,其中进行THP灌注治疗314例,MMC治疗315例;最大随访期内分别有10.5%(33/314)和34.6%(109/315)出现复发。Meta分析结果提示THP组预防肿瘤复发作用统计学上显著优于MMC组(OR0.34,95%CI0.22~0.54,P〈0.05);6项研究报道了治疗毒性(主要是膀胱炎)的比较,Meta分析结果提示THP组膀胱炎发生率明显低于MMC组(OR0.49,95%CI0.29~0.82,P〈0.05)。结论 THP膀胱灌注预防人膀胱癌复发作用优于MMC,但其膀胱炎发生率较MMC低。  相似文献   

2.
BCG-CWS联合IL-2预防浅表性膀胱癌术后复发   总被引:3,自引:0,他引:3  
目的:探讨介苗细胞壁骨架(BCG-WCS)+白细胞介素2(IL-2)膀胱灌注预防浅表性膀胱癌术后复发的临床效果。方法56例浅表性膀胱癌局部手术后随机分为两组,每组28例。分别采用BCG-CWS加IL-2和单用丝裂霉素C(MMC)进行膀胱灌注。结果:56例随访12-30个月,平均22.9个月,BCG-WCS+IL-2组有1例肿瘤复发,MMC组有5例肿瘤复发,两组肿瘤复发率判别有显著性意义(P<0.05);MMC灌注组的毒副反应较BCG-WCS+IL-2组多。结论BCG-CWS联合IL-2预防浅表性膀胱癌术后复发疗效较好,副反应少,临床使用安全可靠。  相似文献   

3.
目的探讨卡介苗、丝裂霉素C交替膀胱内灌注预防浅表性膀胱癌术后复发的疗效。方法回顾性总结分析32例浅表性膀胱癌患者的临床资料,术后应用卡介苗(BCG)120mg、丝裂霉素C(MMC)40mg交替膀胱灌注,每周1次共8次,再每月1次,持续10个月。结果随访12~36个月,32例患者中2例复发(6.3%),所有患者均能耐受上述治疗,2例应用BCG后出现轻度膀胱刺激症状,另有2例镜下血尿。结论BCG、MMC交替膀胱内灌注,预防浅表性膀胱癌术后复发效果满意,患者耐受性好、毒副作用轻,临床应用安全可靠。  相似文献   

4.
目的 比较卡介苗(BCG)与羟基喜树碱(HCPT)膀胱灌注治疗对膀胱癌复发的预防作用及治疗毒性.方法 收集关于BCG与HCPT膀胱灌注治疗膀胱癌的比较性研究文献,进行系统分析.采用优势比(OR)及95%可信区间(CI)作为评价比较疗效及毒性差异的指标.统计软件为RevMan 5.结果 共入选16个临床研究,包括705例接受BCG和905例接受HCPT膀胱灌注治疗的患者.Meta分析结果提示,BCG组1年内复发率高于HCPT组(P=0.009),但2年内复发率和长期复发率差异无统计学意义(P值分别为0.84、0.99).BCG组膀胱刺激症状、血尿和发热的发生率显著高于HCPT组(P均<0.000 01).结论 HCPT膀胱灌注预防膀胱癌1年内复发率低于BCG,2年内复发率和长期复发率无差异,但治疗毒性明显低于BCG.  相似文献   

5.
目的比较吡柔比星早期膀胱灌注与常规灌注对表浅性膀胱癌术后复发的预防和毒性作用。方法检索国内外关于术后吡柔比星早期膀胱灌注与常规灌注治疗表浅性膀胱癌的比较研究,按预设的标准进行筛选纳入5项研究进行质量评价,并提取数据进行Meta分析。结果吡柔比星早期膀胱灌注对预防浅表性膀胱癌术后复发的疗效优于常规灌注组,差异有统计学意义,其优势比及95%可信区间分别为0.45、0.26~0.77(P=0.003〈0.05)。治疗毒性主要是尿路刺激征/腺性膀胱炎。Meta分析显示总的尿路刺激征的发生率在早期灌注组较常规灌注组显著降低,其优势比及95%可信区间分别为0.63、0.41~0.95(P=0.03〈0.05)。结论吡柔比星早期膀胱灌注预防浅表性膀胱癌复发的疗效明显优于常规灌注,毒性作用显著低于常规灌注组。因纳入研究有限,建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。  相似文献   

6.
目的 探讨卡介苗(BCG)维持膀胱灌注对T1G3浅表性膀胱癌术后复发的影响. 方法应用Meta分析固定效应模型和随机效应模式对有关BCG维持灌注与T1G3浅表性膀胱癌术后复发的文献进行综合定量评价,并进一步采用分层分析判定不同BCG菌株与T1G3浅表性膀胱癌术后复发的具体关系. 结果纳入Meta分析15篇文献1648例患者,其中采用BCG灌注治疗915例,未采用BCG灌注治疗733例.术后腔内维持灌注BCG者膀胱癌复发率为41.0%(375/915),未灌注组为45.3%(332/733).BCG维持灌注与T1G3浅表性膀胱癌术后复发的合并OR值为0.58(95%可信区间0.41~0.83,P=0.003),不同BCG菌株维持灌注与T1G3浅表性膀胱癌术后复发的合并OR值分别为0.50(95%可信区间0.26~0.95,P=0.04)和0.63(95%可信区间0.40~0.99,P=0.04).结论 BCG维持灌注可有效降低T1G3浅表性膀胱癌患者术后的复发率.  相似文献   

7.
目的:比较卡介苗与丝裂霉素C膀胱灌注预防国人膀胱癌复发的疗效及毒性。方法:检索国内已公开发表的关于卡介苗与丝裂霉素C膀胱灌注治疗国人膀胱癌复发的比较性研究资料,对纳入研究的资料进行统计学综合(Meta分析)。结果:共有16个研究符合标准被纳入,涉及总病例数1242例,其中进行卡介苗灌注治疗708例,丝裂霉素C治疗534例;最大随访期内分别有23.4%(166/708),30.7%(164/534)出现复发。Meta分析结果提示卡介苗组预防肿瘤复发作用统计学上显著优于丝裂霉素C组(OR0.63,95%CI0.48~0.83,P=0.001);9个研究报道了治疗毒性主要是膀胱炎的比较,Meta分析结果提示卡介苗组膀胱炎发生率明显高于丝裂霉素C组(OR4.52,95%CI1.11~18.36,P=0.03)。结论:卡介苗膀胱灌注预防国人膀胱癌复发作用优于丝裂霉素C,但其毒性(膀胱炎发生率)较丝裂霉素C高。  相似文献   

8.
目的探讨膀胱内灌注纤维蛋白溶解抑制药物增强卡介苗(BCG)预防膀胱癌术后复发的疗效。方法将208例浅表性膀胱移行细胞癌(BTCC)患者术后随机分成5组,A组44例,定期膀胱内灌注BCG100~120mg+氨甲苯酸(PAMBA)0.1g+生理盐水,B组4l例,灌注BCG50~60mg+PAMBA0.1g+生理盐水,C组4l例,灌注BCG100~120mg+氨基己酸(EACA)2.0g+生理盐水,D组39例,灌注BCG50~60mg+EACA2.0g+生理盐水,E组43例,灌注BCG100~120mg+生理盐水。每周1次,6次后每月1次。灌注后每3个月作膀胱镜检查,必要时取活检明确肿瘤有无复发。结果随访4~58个月,平均22个月,A~E组BTCC复发率分别为10.3%、8.6%、9.7%、9.7%和29.7%。A、B、C、D各组抗BTCC复发的疗效均明显优于E组(对照组),差异有统计学意义(P〈0.05);B、D组预防BTCC术后复发的效果与A、C组比较差异无统计学意义。结论膀胱内灌注纤维蛋白溶解抑制药物PAMBA、EACA可增强BCG预防膀胱癌术后复发的疗效,BCG剂量减半后,疗效不降低。  相似文献   

9.
目的:研究同期经尿道手术治疗浅表性膀胱癌合并前列腺增生对膀胱癌复发率及种植性转移率的影响。方法:检索国内外关于同期经尿道手术与分期手术治疗浅表性膀胱癌并前列腺增生的比较研究,按预设的标准进行筛选,对纳入研究进行质量评价,并提取数据进行统计学分析(Meta分析)。以总复发率及膀胱颈/前列腺窝复发率为终点指标,用优势比(0R)和95%置信区间(CI)评价。结果:共6个研究符合标准被纳入,其中国外5个,国内1个,总病例数761例,其中同期手术组377例,分期手术组384例;最大随访期内分别有36.3%(137/377),46.3%(178/384)出现复发。Meta分析结果显示同期手术组术后复发率统计学上显著低于分期手术组(OR0.63,95%C10.47~0.86);5%(19/377)的同期手术组患者和4.7%(18/384)分期手术患者发生膀胱颈/前列腺窝复发,两组比较差异无统计学意义(OR1.09,95%C10.55~2.14)。结论:同期经尿道手术治疗浅表性膀胱癌合并前列腺增生可降低肿瘤复发率,而不增加膀胱颈/前列腺窝种植性转移概率。  相似文献   

10.
目的改进丝裂霉素C膀胱灌注治疗方案,提高其预防浅表性膀胱癌电切术后复发的疗效。方法62例初发浅表性膀胱癌患者随机分为常规组和改良组。术后随访5年。结果肿瘤5年复发率常规组为55.2%,改良组为32.8%,经log-rank检验,差异有统计学意义(P〈0.05)。出现膀胱不良反应常规组10例,改良组12例,经χ^2检验无统计学意义(P〉0.05)。结论改良丝裂霉素C膀胱灌注化疗可以有效预防初发浅表性膀胱癌电切术后复发。  相似文献   

11.
12.
羟基喜树碱预防膀胱肿瘤术后复发的系统评价   总被引:8,自引:0,他引:8  
目的:评价膀胱灌沣羟基喜树碱预防国人膀胱肿瘤术后复发的疗效和副作用。方法:按设定的纳入杯准,检索国内已公开发表的关于羟基喜树碱膀胱灌注治疗国人膀胱肿瘤术后复发的研究资料,并应用Revman1.2软件进行数据处理和分析。结果:共有16个研究符合标准被纳入,涉及总病例数1671例.其中进行羟基喜树碱灌注治疗779例(193/779),对照组治疗892例(267/892)。Meta分析结果提示羟基喜树碱膀胱灌注可降低膀胱肿瘤复发风险(OR=0.76.95%CI[0.61.0.96],P=0.02);与13个研究主要副作用膀胱刺激痱化学性膀胱炎的文献比较,Meta分析结果提示羟基喜树碱膀胱灌注所致膀胱刺激症化学性膀胱炎发生率极低(OR=0.08.95%CI[0.03,0.19]P<0.00001)。结论:羟基喜树碱膀胱灌注可以有效降低膀胱肿瘤术后复发率,虽然也可以引起一些副作用,但可以耐受,不影响患者继续治疗。  相似文献   

13.
Background Long-term results after transurethral resection (TUR) and prophylactic intravesical Tokyo 172 bacillus Calmette-Guerin (BCG) therapy for primary superficial bladder cancer were analyzed by multivariate analysis, and factors affecting the recurrence of bladder tumors after this therapy were examined.
Methods One-hundred and forty-one consecutive patients with primary superficial bladder cancer who consulted the Department of Urology at Wakayama Medical College and affiliated hospitals between May 1985 and May 1990 were studied. Tokyo strain BCG was given intravesically (80 mg in 40mL saline) weekly for 6 weeks.
Results The 5-year cumulative recurrence-free rate by the Kaplan-Meier method was 0.702 in 141 patients with primary superficial bladder cancer. The 5-year recurrence-free function using the proportional hazard model was 0.743. Using the Cox proportional hazard model, variables that significantly contributed to recurrence after intravesical BCG included female sex, tumor size less than 1 cm in diameter, and T1 tumor stage. Patient age, tumor type, multiplicity, tumor grade, and concomitant carcinoma in situ did not contribute to recurrence.
Conclusion Long-term results showed that prophylactic intravesical Tokyo strain BCG after TUR for primary superficial bladder cancer is also effective in preventing the recurrence of bladder cancer, and the biologic behavior of superficial bladder cancer other than stage T1 tumor may be altered after intravesical BCG.  相似文献   

14.
INTRODUCTION: Superficial bladder cancer can be treated by transurethral resection (TUR) and adjuvant intravesical therapy. Intravesical bacillus Calmette-Guérin (BCG) has been proven to be more efficacious with respect to recurrence prevention than intravesical chemotherapy, although at the cost of more severe side effects. There is a need for a new treatment modality with higher efficacy and less toxicity. The subject of this study is the efficacy of local microwave hyperthermia and chemotherapy treatment in intermediate or high risk superficial transitional cell carcinoma (TCC) of the bladder. PATIENTS AND METHODS: Ninety eligible patients received adjuvant treatment with a combination of mitomycin-C (MMC) and local microwave hyperthermia. All patients had multiple or recurrent Ta or T1 TCC of the bladder and were classified as intermediate or high risk according to EAU criteria. In total, 41 patients were BCG failures. The treatment regimen included 6 to 8 weekly sessions followed by 4 to 6 monthly sessions. Follow-up consisted of video-cystoscopy and urine cytology every 3 months. All patients were observed for 2 years. RESULTS: Kaplan-Meier analyses of the total group (N = 90) indicated that 1 year after treatment only 14.3% (SE 4.5%) of all patients experienced a recurrence. After 2 years of follow-up the risk of recurrence was 24.6% (SE 5.9%). No progression in stage and grade was observed. CONCLUSION: Microwave induced hyperthermia combined with MMC has promising value in intermediate or high risk superficial bladder cancer patients compared to literature data of BCG and/or intravesical chemotherapy, particularly where other treatments, i.e. BCG, have failed.  相似文献   

15.
膀胱癌mdr-1 mRNA表达水平及临床意义   总被引:2,自引:0,他引:2  
目的探讨浅表性膀胱癌MMC和BCG/MMC膀胱灌注疗效与mdr1表达的相关性。方法应用逆转录多聚酶链反应(RTPCR)技术,追踪检测71例膀胱癌治疗前后的mdr1表达量。结果用MMC灌注者其复发肿瘤mdr1表达明显增加,而用BCG/MMC灌注则无明显增加;MMC组复发率42%,复发中位时间14.5个月;而BCG/MMC组复发率为24%,复发中位时间30.5个月。结论MMC可诱导膀胱癌产生MDR;BCG/MMC疗效明显优于MMC,尤其对mdr1阳性表达病例,且延缓癌细胞MDR增加。  相似文献   

16.
In a prospective randomized trial intravesical prophylaxis for recurrence of superficial bladder cancer with BCG versus KLH was performed in 42 patients, 38 of whom were then evaluable. After a mean observation period of 20 +/- 7 months (8-32 months) 41.2% (7/17) of the patients in the KLH and 14.3% (3/21) of the patients in the BCG group developed recurrent bladder tumours. The recurrence rate according to EORTC was 1.95 in the KLH group versus 0.76 in the BCG group. Among the BCG treated patients, 60% (15/25) had cystitis and 28% (7/25) fever, whereas only 1 of 19 (5.3%) patients treated with KLH had cystitis. BCG is a highly effective prophylactic against recurrence of superficial bladder cancer. Intravesical instillation therapy with KLH has only a slight prophylactic effect if treatment is started 6 weeks postoperatively.  相似文献   

17.
PURPOSE: We determined the short-term and long-term efficacy of bacillus Calmette-Guerin (BCG) and chemotherapy in the treatment of patients with carcinoma in situ (CIS). MATERIALS AND METHODS: A meta-analysis was performed on published results of randomized clinical trials comparing intravesical BCG to intravesical chemotherapy. RESULTS: Nine randomized trials including 700 patients with CIS compared BCG to either mitomycin C (MMC), epirubicin, adriamycin, or sequential MMC/adriamycin. Of 298 patients on BCG 203 (68.1%) had a complete response compared with 158 of 307 patients on chemotherapy (51.5%), a reduction of 47% in the odds of nonresponse on BCG (OR 0.53, p =0.0002). Based on a median followup of 3.6 years, 161 of 345 patients on BCG (46.7%) had no evidence of disease compared with 93 of 355 patients on chemotherapy (26.2%), a reduction of 59% in the odds of treatment failure on BCG (OR 0.41, p <0.0001). Although the long-term benefit of BCG was smaller in trials with MMC, BCG was superior to MMC in trials with maintenance BCG (OR 0.57, p =0.04). The reduction of 26% in the risk of progression on BCG (p =0.20) is consistent with the reduction of 27% (p =0.001) previously reported in a larger superficial bladder cancer meta-analysis. CONCLUSIONS: Intravesical BCG significantly reduces the risk of short and long-term treatment failure compared with intravesical chemotherapy. Therefore, it is considered to be the intravesical agent of choice in the treatment of CIS.  相似文献   

18.
MMC和BCG交替灌注防治膀胱癌术后复发   总被引:2,自引:0,他引:2  
目的:观察丝裂霉素C(MMC)和卡介苗(BCG)化学免疫预防膀胱癌术后复发的疗效。方法:对86例浅表性膀胱癌患者术后应用MMC20mg和BCG60mg,每周1次进行交替膀胱藻注,共灌注12次,以后每间隔3个月灌注1次,持续2年,结果:随记2.4-8年,平均4.84年,肿瘤复发率为8.1%,结论:MMC和BCG交替膀胱灌注可减少膀胱癌术后复发率。  相似文献   

19.
目的 比较吡柔比星与其他灌注化疗药物预防膀胱肿瘤复发的疗效. 方法检索Medline、EMBase、CBMDisc等文摘数据库以及PubMed、ScienceDirect、Lww、Springer、中国期刊全文数据库、中文科技期刊数据库等全文数据库,收集并按照纳入和排除标准筛选已发表的关于吡柔比星与其他膀胱灌注化疗药物预防膀胱肿瘤术后复发疗效比较的对照研究,提取纳入研究中关于复发的数据进行Meta分析. 结果共获得15个符合标准的研究.其中10个研究比较了吡柔比星和丝裂霉素的疗效,Meta分析显示,吡柔比星预防膀胱肿瘤复发的疗效显著优于丝裂霉素(OR=0.41,95%CI0.27~0.61,P<0.01);6个研究分别比较了吡柔比星与噻替哌(OR=0.35,95%CI 0.11~1.13,P>0.05)、阿霉素(OR=0.15,95%CI 0.03~0.76,P<0.05)、表阿霉素(OR=0.53,95%CI 0.23~1.23,P>0.05)、羟基喜树碱(OR=0.25,95%CI 0.10~0.64,P<0.05)等药物以及空白对照组的疗效,统计学分析显示吡柔比星疗效显著优于羟基喜树碱、阿霉素以及空白对照组,而与噻替哌和表阿霉素疗效的差异无统计学意义. 结论吡柔比星能有效预防膀胱肿瘤术后复发,其疗效优于丝裂霉素、羟基喜树碱、阿霉素等药物,是新的可选择的膀胱肿瘤灌注化疗药物.  相似文献   

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