膀胱癌TURBT术后吉西他滨膀胱热灌注临床疗效分析

目的探讨膀胱癌行经尿道膀胱肿瘤电切术(TURBT)后行吉西他滨膀胱热灌注治疗的临床疗效。方法选择2015年2月~2017年2月我院收治的膀胱尿路上皮细胞癌患者60例,随机分为两组,各30例:观察组行45℃吉西他滨热灌注治疗,对照组行吉西他滨常规膀胱灌注治疗。两组治疗持续时间和化疗方案一致。比较两组患者治疗前后血清可溶性细胞间黏附分子-1(sICAM-1)、血清前梯度蛋白2(AGR2)水平,远期生存率、复发及不良反应情况。结果灌注治疗后两组患者sICAM-1和AGR2水平均较灌注前显著下降(P<0.05),且观察组sICAM-1和AGR2水平低于对照组(P<0.05)。观察组2年总复发率和非原位复发率分别为13.33%和3.33%,低于对照组的36.67%和26.67%(P均<0.05);观察组2年无复发生存期平均(22.43±3.41)个月,较对照组(19.04±3.12)个月延长(P<0.05)。两组不良反应率比较无统计学差异(P>0.05)。结论吉西他滨膀胱热灌注治疗可有效降低膀胱癌患者血清sICAM-1和AGR2水平,预后好,能降低TURBT术后复发率,延长生存期,且安全性与常规灌注治疗相近,其治疗膀胱癌的临床前景可期。

Clinical Analysis of Hyperthermic Intravesical Perfusion of Gemcitabine after TURBT for Uroepithelium Cell Carcinoma of Bladder

Objective To study the effect of gemcitabine hyperthermic intravesical chemotherapy(HIVEC)on the levels of serum soluble intercellular adhesion molecule 1(sICAM-1)and anterior gradient-2(AGR2),the recurrence rate and the prognosis in the patients with bladder uroepithelium cell cancer after TURBT.Methods A random study was performed in 60 cases suffered bladder uroepithelium cell carcinoma from February 2015 to February 2017.The intravesical hyperthermic instillation of gemcitabine at 45℃was carried out in the observation group(n=30),and the routine intravesical chemotherapy of gemcitabine was performed in the control group(n=30).The chemotherapy regimen,dosage and duration were same in both groups.The serum levels of sICAM-1 and AGR2,long term survival rate,recurrence rate and adverse reactions were compared between the two groups.Results The levels of sICAM-1 and AGR2 was decreased significantly in both groups after the perfusion than those before the perfusion(P<0.05),and both sICAM-1 and AGR2 was lower in the observation group than those in the control group(P<0.05).The total recurrence rate and non-in situ recurrence rate was 13.33%and 3.33%respectively in the observation group,and both were lower than 36.67%and 26.67%respectively in the control group(P<0.05).The 2-year recurrence-free survival period of the observation group was(22.43±3.41)months,and was longer than(19.04±3.12)months of the control group(P<0.05).There was no statistical difference in the adverse reaction rate between the two group(P>0.05).Conclusion HIVEC of gemcitabine can effectively reduce the serum levels of sICAM-1 and AGR2,decrease the recurrence rate,prolong the survival period and achieve the reliable safety consistent with the conventional perfusion for bladder cancer patients after TURBT,and it has got a good prognosis and a promising clinical prospect.