不同预防性膀胱内化疗方案对上尿路尿路上皮癌肾输尿管切除术后膀胱癌复发的影响

目的:比较不同预防性膀胱灌注化疗方案对UTUC患者的OS、CSS、IVRFS的影响。方法:回顾性分析2010年至2020年在我院泌尿外科接受RNU手术的387例UTUC患者的临床病例资料。术后随访10年，观察生存情况，同时对于患者的临床病理相关性数据进行统计学分析，选择Log-rank检验和Kaplan-Meier法，单因素多因素生存分析选择Cox回归分析。结果:所有患者的中位年龄为67岁［四分位数范围(IQR):33~90岁］，所有患者的中位随访时间为44个月［四分位数范围(IQR):3~140月］。三组患者的基线资料方面没有显著差异。Kaplan-Meier曲线显示，灌注组与未灌注组间，未灌注组、单次灌注组、多次灌注组三组间的总体生存率(OS)均有显著差异(P<0.000 1)，三组间的肿瘤特异性存活率(CSS)有显著差异(P<0.000 1)，同样三组间的膀胱内无复发生存率(IVRFS)也有显著差异(P=0.005)。未灌注组、单次灌注组与多次灌注组三组患者的1年，3年和5年的OS分别为85.3%、70.2%和61% vs 96.1%、84.1%和73.5% vs 96.8%、88.5%和84.3%。三组患者的1年，3年和5年的CSS分别为86.6%、73.6%和66.6% vs 97.4%、85.2%和74.4% vs 97.8%、89.4%和87%。三组患者的1年，3年和5年的IVRFS分别为95.2%、86.7%和74.1% vs 98.5%、89.4%和81.1% vs 98.9%、94.7%和88%。结论:术后膀胱内化疗可以明显降低UTUC患者的膀胱内复发率，尤其是侵袭性或高度恶性的UTUC。此外，我们认为多次膀胱灌注的疗效可能优于单次灌注。

A comparison of different prophylactic intravesical chemotherapy regimens for bladder cancer recurrence after nephroureterectomy for upper tract urothelial carcinoma

Objective:To compare the effects of different prophylactic intravesical chemotherapy on OS,CSS and IVRFS in patients with UTUC.Methods:Clinical data of 387 UTUC patients who received RNU surgery in urology department of our hospital from 2010 to 2020 were retrospectively analyzed.The patients were followed up for 10 years after the operation to observe the survival.At the same time,the clinicopathological correlation data of the patients were statistically analyzed,and log-rank test and Kaplan-Meier method were selected.Cox regression analysis was used for univariate and multivariate survival analysis.Results:The median age of all patients was 67 years［quartile range (IQR):33~90 years］,and the median follow-up time of all patients was 44 months［quartile range (IQR):2~140 months］.There were no significant differences in baseline data among the three groups.Kaplan-Meier curves showed that there were significant differences in overall survival (OS) between the instillation group and the non-instillation group,the no-instillation group,single-instillation and multiple instillation group (P<0.000 1),and significant differences in cancer-specific survival (CSS) between the three groups (P<0.000 1).There was also a significant difference in intravesical recurrence free survival (IVRFS) between the three groups (P=0.005).The 1-year,3-year,and 5-year overall survival (OS) in the no-instillation group,single-instillation and multiple instillation group were 85.3%,70.2% and 61% vs 96.1%,84.1% and 73.5% vs 96.8%,88.5% and 84.3%,respectively.The 1-year,3-year,and 5-year cancer-specific survival (CSS) were 86.6%,73.6% and 66.6% vs 97.4%,85.2% and 74.4% vs 97.8%,89.4% and 87% in the three groups,respectively.The 1-year,3-year,and 5-year intravesical recurrence free survival (IVRFS) were 95.2%,86.7%,and 74.1% vs 98.5%,89.4%,and 81.1% vs 98.9%,94.7%,and 88%,respectively.Conclusion:Postoperative intravesical chemotherapy can significantly reduce the recurrence rate of patients with UTUC,especially for invasive or highly malignant UTUC.In addition,we suggest that multiple-instillations may be superior to single-instillations.