不同剂量表柔比星膀胱灌注预防浅表性膀胱癌复发的疗效与安全性

目的比较不同剂量表柔比星膀胱灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法90例浅表性膀胱癌患者根据开放的、前瞻性的、随机分组的方法,分别采用不同剂量表柔比星膀胱内灌注化疗,随访2年,观察患者肿瘤复发和不良反应。结果表柔比星80mg单次灌注组、40mg多次灌注组和50mg多次灌注组术后1年复发率分别为16．7％、13．3％和16．7％,2年复发率分别为50．0％、36．7％和36．7％。3组术后1年复发率差异无统计学意义（P〉0．05）,但2年时单次灌注组的复发率显著高于多次灌注组（P〈0．05）。表柔比星80,职单次灌注组、40mg多次灌注组和50mg;多次灌注组的不良反应发生率分别为23．3％、40．0％和33．3％,灌注次数愈多,不良反应发生率愈高。结论表柔比星术后早期、单次、大剂量灌注配合每月1次低剂量灌注预防浅表性膀胱癌复发,可能是一种安全、经济、有效的方法。     

膀胱癌电切术后膀胱灌注多柔比星脂质体治疗浅表性膀胱癌的疗效观察

目的:探讨经尿道电切术后膀胱灌注多柔比星脂质体治疗浅表性膀胱癌的临床疗效。方法:78例患者随机分为2组:表柔比星灌注组（EOX）和多柔比星脂质体组（DOL）,随访比较2组患者术后复发情况和不良反应。结果:术后12个月和24个月,DOL复发率分别为5.0%和10.0%,明显低于EOX复发率18.4%和26.3%（P<0.05)。DOL组不良反应发生率低于EOX组（P<0.05）。结论:经尿道膀胱肿瘤电切术后膀胱灌注多柔比星脂质体疗效优于表柔比星而不良反应发生率低于表柔比星。     

经尿道膀胱肿瘤电切术术后即刻表柔比星灌注化疗在非肌层浸润性膀胱癌患者中的应用效果

目的 探讨经尿道膀胱肿瘤电切术(TURBT)术后即刻表柔比星灌注化疗在非肌层浸润性膀胱癌患者中的应用效果.方法 根据化疗方式的不同将63例非肌层浸润性膀胱癌患者分为观察组(n=33)和对照组(n=30),均接受TURBT治疗,观察组患者术后即刻给予表柔比星灌注化疗,对照组患者术后1周给予表柔比星灌注化疗.比较两组患者肿...     

表柔比星与丝裂霉素膀胱内单次与多次灌注预防浅表性膀胱癌术后复发

目的：研究表柔比星单次与多次灌注预防浅表性膀胱癌术后复发的有效性，比较与丝裂霉素疗效的差异，探讨表柔比星单次腔内灌注预防浅表性膀胱癌术后复发的可行性。方法：对多中心人选病便行前瞻性、随机对照临床研究，随访患者肿瘤复发及不良反应发生情况。结果：表柔比星单次灌注组（Ａ组，８０ｍｇ／次）、多次灌注组（Ｂ组，４０ｍｇ／次）及丝裂霉素多次灌注组（Ｃ组，４０ｍｇ／次）病例术后１年复发率分别为２２．２％（８／３     

TUR-BT术后行表柔比星、吉西他滨序贯膀胱灌注治疗非肌层浸润性膀胱癌的临床观察

目的:观察表柔比星(EPI)、吉西他滨(GEM)序贯膀胱灌注辅助手术治疗非肌层浸润性膀胱癌的临床效果。方法:非肌层浸润性膀胱癌患者118例,均行经尿道膀胱肿瘤切除术(TUR-BT)。术后分别行EPI(EPI组,40例)、GEM(GEM组,36例)和EPI、GEM序贯(序贯组,42例)膀胱灌注治疗,观察三组膀胱癌复发、进展和不良反应情况。结果:全部病例随访二年,序贯组膀胱癌复发率低于EPI组和GEM组(P均<0.05),EPI与GEM组复发率无明显差异。各组膀胱癌进展率无明显差异(P均>0.05)。EPI组、GEM组、序贯组分别有3、3、4例出现轻度膀胱刺激症状,无其他不良反应。结论:EPI、GEM序贯膀胱灌注辅助手术治疗非肌层浸润性膀胱癌可降低术后二年内复发率,但不能改变膀胱癌的进展。     

表柔比星、卡介苗预防非肌层浸润性膀胱癌术后复发的荟萃分析

背景与目的：膀胱癌是泌尿系最常见的恶性肿瘤。对于非肌层浸润性膀胱癌，术后腔内灌注是预防其复发的重要措施。卡介苗被认为是最有效的免疫治疗制剂，而表柔比星是已报道肿瘤完全缓解率较高的灌注化疗药物。但两种制剂在膀胱癌的疗效比较尚无定论：本文收集相关资料，以期比较表柔比星、号介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发、疾病进展的疗效和副作用。方法：按文中所述纳入标准，检索国内外已公开发表的关于表柔比星、卡介苗膀胱灌注治疗非肌层浸润性膀胱癌的比较性研究文献，并应用Revman 4．2软件进行数据处理和分析。结果：共有6个研究符合标准被纳入，涉及总病例数1288例，其中表柔比星灌注治疗657例，复发253例；卡介苗治疗631例，复发184例。Meta分析结果提示卡介苗预防复发的疗效优于表柔比星，且统计学差异有显著性（Peto OR=1．60，95％CI=[1．26，2．03]，P=0．0001）；在预防疾病进展方面，卡介苗同样优于表柔比星（Peto OR=1．70，95％CI=[1．16，2．49]，P=0．006）；5个研究报道了药物主要局部副作用的比较，Meta分析显示表柔比星组在血尿（Peto OR=0．47，95％CI=[0．35，0．62]，P〈0．00001）、膀胱炎／膀胱刺激症（Peto OR=0．23，95％CI=[0．11，0．48]，P〈0．0001）发生率上显著低于卡介苗组。结论：卡介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发及疾病进展作用优于表柔比星，但副作用发生率明显升高，选择病例需谨慎。     

浅表膀胱癌膀胱内灌注治疗

浅表膀胱癌膀胱内灌注治疗华西医科大学附属第一医院泌尿外科（６１００４１）唐孝达膀胱癌中７５％～８０％为浅表膀胱移行细胞癌。其中Ｔａ期肿瘤复发率低，而Ｔ１期肿瘤，尤其是高分级肿瘤，复发率可高达７５％，向深层浸润者４３％。膀胱内灌注治疗已广泛用于浅表膀胱...     

羟基喜树碱膀胱灌注加高频透热治疗36例膀胱癌

自 1 996年 1 0月～ 2 0 0 0年 1 0月 ,我们对 36例术后复发和未手术膀胱癌患者采用羟基喜树碱 (HPCT)膀胱灌注加高频透热治疗 ,获得了较满意的效果。　　 材料和方法一研究对象本组 36例患者 ,经病理证实均为膀胱恶性肿瘤 ,其中移行细胞癌 32例 ,腺癌 4例。男性 2 6例 ,女性 1 0例 ,年龄 31～ 80岁 ,平均年龄为 59岁。未手术者 1 1例 ,其中初治 8例 ,化疗后复发 3例 ;术后复发 2 5例。二治疗方法　HPCT 1 2mg加 0 9%氯化钠注射液 60ml。消毒后将导尿管插入膀胱 ,排空尿液后灌注入药液。每1 5分钟变换 1次体位 ,药液在膀胱内保留 2小时…     

吡柔比星膀胱内灌注预防浅表性膀胱癌术后复发的观察

我院自 1998年 5月 - 2 0 0 0年 9月对 2 9例浅表性膀胱部分切除术或TU R- BT术后的病例 ,应用吡柔比星定期膀胱灌注化疗 ,预防肿瘤复发。经随访观察 ,初步疗效满意 ,现报告如下。1　资料与方法1.1　一般资料　本组 2 9例 ,男性 2 3例 ,女性 6例。年龄 46岁～ 80岁 ,平均63岁。均初发 ,多发肿瘤 4例。 7例行膀胱部分切除术 ,2 2例行 TU R- BT术 ,术后病理证实 :移行上皮癌 (T1 ,G1 ～ G2 )。1.2　灌注方法　术后 1周～ 2周开始灌注 ,THP2 0 mg溶于 40 m L 注射用水 ,充分溶解药物 ,常规消毒后置导尿管入膀胱 ,排净尿液后灌药 ,膀胱内…     

恶性肿瘤患者表柔比星化疗后心电图异常情况

表柔比星与阿霉素均属于蒽环类抗肿瘤药物,且已被证实具有较好的治疗效果。阿霉素的心脏毒性等毒副反应较重,近年来已较少应用,但是表柔比星作为新一代的替代型蒽环类药物,虽然毒副反应有了明显降低,但心脏毒性的发生率依然较高[1]。作者收集本院     

Urinary diversion and morbidity after radical cystectomy for bladder cancer

BACKGROUND:

The rate of continent urinary diversion after radical cystectomy for bladder cancer varies by patient and provider characteristics. Demonstration of equivalent complication rates, independent of diversion type, may decrease provider reluctance to perform continent reconstructions. The authors sought to determine whether continent reconstructions confer increased complication rates after radical cystectomy.

METHODS:

From the Nationwide Inpatient Sample, the authors used International Classification of Disease (ICD‐9) codes to identify subjects who underwent radical cystectomy for bladder cancer during 2001‐2005. They determined acute postoperative medical and surgical complications from ICD‐9 codes and compared complication rates by reconstruction type using the nearest neighbor propensity score matching method and multivariate logistic regression models.

RESULTS:

Adjusting for case‐mix differences between reconstructive groups, continent diversions conferred a lower risk of medical, surgical, and disposition‐related complications that was statistically significant for bowel (3.1% lower risk; 95% confidence interval [95% CI], ?6.8% to ?0.1%), urinary (1.2% lower risk; 95% CI, ?2.3%, to ?0.4%), and other surgical complications (3.0% lower risk; 95% CI, ?6.2% to ?0.4%), and discharge other than home (8.2% lower risk; 95% CI, ?12.1% to ?4.6%) compared with ileal conduit subjects. Older age and certain comorbid conditions, including congestive heart failure and preoperative weight loss, were associated with significantly increased odds of postoperative medical and surgical complications in all subjects.

CONCLUSIONS:

Mode of urinary diversion after radical cystectomy for bladder cancer is not associated with increased risk of immediate postoperative complications. These results may encourage broader consideration of continent urinary diversion without concern for increased complication rates. Cancer 2010. © 2010 American Cancer Society.     

Intravesical administration of exogenous microRNA-145 as a therapy for mouse orthotopic human bladder cancer xenograft

We previously reported that the level of microRNA (miR)-145 is attenuated in human bladder cancer cells. In this current study, we investigated whether intravesical administration of miR-145 could be a potential therapeutic strategy for controlling bladder cancer by using an orthotopic human bladder cancer xenograft model. Following transfection of 253J B-V cells with miR-145, the effects of the ectopic expression of miR-145 were examined by performing MTT, Western blotting analysis, Hoechst33342 staining, and wound healing assay in vitro. Also, a mouse orthotopic human bladder cancer model was established by inoculating 253J B-V cells into the bladder wall of mice. The anti-cancer effects of intravesical injections of miR-145 into these mice were then assessed. Transfection of 253J B-V cells with miR-145 induced apoptosis and suppression of cell migration in vitro. Western blotting showed that the levels of c-Myc, socs7, FSCN1, E-cadherin, β-catenin, and catenin δ-1 were decreased and that the PI3K/Akt and Erk1/2 signaling pathways were increased in compensatory fashion. In vivo, mice treated with miR-145 showed 76% inhibition of tumor growth, with a significant prolongation of animal survival (p = 0.0183 vs. control). Western blotting showed that both apoptosis and cell motility-related genes were significantly decreased as seen in vitro. Furthermore, PI3k/Akt and Erk1/2 signaling pathways, which were activated in a compensatory manner in vitro, were decreased in vivo. Intravesical administration of exogenous miR-145 was thus concluded to be a valid therapy for bladder cancer in this human bladder cancer xenograft model.     

Controversial issues and optimal management of stage T1G3 bladder cancer

The management of T1G3 bladder cancer is controversial. Diagnostic methods, such as bladder mapping or second-look transurethral resection are recommended to assess risk. Bacillus Calmette–Guérin intravesical therapy with a maintenance regimen is recommended for solitary T1G3 tumors. The timing of radical cystectomy for these patients is controversial, but early recurrence during intravesical therapy is an indication for radical cystectomy. Multifocal disease, concomitant carcinoma in situ and disease in the prostatic urethra and bladder neck also suggest aggressive disease and cystectomy should be considered in these patients.     

男性全膀胱切除后下尿路功能重建——附120例报告

目的 改良全膀胱切除和原位新膀胱术治疗浸润性膀胱癌的临床经验.方法 采用改良全膀胱切除和原位新膀胱术治疗局部浸润性膀胱癌患者120例,均为男性,平均年龄55.6岁.120例中移行细胞癌113例,鳞癌3例,腺癌4例.TNM临床分期T2N0M0101例、T3N0M0 7例、T3N1M0 2例.统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和病人生存情况进行随访分析.结果 120例患者无手术死亡,手术时间185～332分钟,平均254分钟.术中出血150～1270 ml,输血40例.病理分期T1N0M0 3例,T2N0M0 111例,T3aN0M0、T3aN1M0和T3bN1M0各2例.随访4～71个月,平均37个月.111例无瘤生存,因肿瘤死亡9例.新膀胱白天控尿良好112例(93.3%),夜间控尿良好95例(79.2%).残余尿量0～100 ml 112例,101～250 ml 8例.主要并发症:切口裂开3例,二次缝合治愈;输尿管吻合口漏1例,再吻合后治愈;输尿管口狭窄4侧,2侧经内镜下切开和扩张纠正,2侧行输尿管新膀胱再吻合治愈.输尿管口粘连4侧,经内镜下手术纠正;严重肠梗阻3例和慢性酸中毒低钾2例,均经内科处理纠正.结论 改良全膀胱切除和原位新膀胱术后严重并发症少、肿瘤控制满意,重建的新膀胱功能良好,能较好保持患者的生活质量,是目前治疗浸润性膀胱癌最理想的方法之一.     

吡柔比星膀胱灌注预防膀胱癌术后复发临床观察

目的:分析2002年6月~2005年8月间158例浅表性膀胱癌患者行膀胱部分切除术或行TUR-Bt术后采用吡柔比星(THP)膀胱灌注预防肿瘤复发。方法:THP30mg,每周1次,连用8周,而后每月1次,连用10个月,总疗程12个月。结果:所有患者均获6~24个月的随访。平均随访12.3个月。复发20例,复发率12.8%。结论:THP用于膀胱灌注预防膀胱癌术后复发有较好的疗效,不良反应少,给药方便,值得临床推广应用。     

吡柔比星膀胱灌注预防浅表性膀胱癌术后复发的临床观察

目的评价浅表性膀胱癌行经尿道膀胱肿瘤电切术或膀胱部分切除术后应用吡柔比星(THP)膀胱灌注化疗预防复发的预期疗效和安全性.方法对28例浅表性膀胱癌行经尿道膀胱肿瘤电切术或膀胱部分切除术,术后应用THP(30mg/50ml)膀胱灌注,保持30分钟.结果随访3～18个月,无肿瘤复发.结论THP用于膀胱灌注预防浅表性膀胱癌术后复发是安全且疗效显著.     

保留膀胱的综合治疗与根治性手术治疗肌层浸润性膀胱癌预后的荟萃分析

目的 比较保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌的预后.方法 检索保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的对照研究,比较两种治疗方案的术后5年生存率,计算合并优势比(OR)和95%CI.结果 共纳入7项研究,累积876例患者.1组研究的OR=1.03,95%CI为1.03(0.52~2.02),4组研究的OR及其95%CI﹤1,2组研究的OR及其95%CI﹥1;7个研究的总OR=1.05,95%CI为1.05(0.53~2.06),跨过"无差异线",故认为根治性膀胱全切术(radical cystectomy,RC)与保留膀胱的综合治疗预后差异无统计学意义(Z=0.13,P=0.89).结论 对于部分肌层浸润性膀胱癌患者,保留膀胱的综合治疗不会降低患者的5年生存率,且能保留患者膀胱的正常功能,提高了患者的生存质量,但适应证需严格把握.     

Minimally invasive cystectomy approaches in the treatment of bladder cancer

Bladder cancer is the most frequently occurring tumor of the urinary system, with over 10,000 new diagnoses each year in the UK. Approximately 70% of these are non-muscle-invasive and limited to the mucosa (Ta) or submucosa (T1). These tumors are generally managed with transurethral resection followed by adjuvant intravesical chemo- or immuno-therapy and regular cystoscopic surveillance. The principal end points in the management of these tumors are prevention of recurrence and progression. Muscle-invasive bladder cancer is a life-threatening disease with overall 5-year mortality of 50%. Neoadjuvant chemotherapy, where possible followed by radical surgery, is currently considered the best standard of care. Open radical cystectomy is the gold-standard treatment for muscle-invasive or high-risk non-muscle-invasive (multifocal or recurrence after intravesical therapy) bladder cancer. Historically, this procedure has carried significant morbidity, although mortality of open radical cystectomy has reduced to 1–2% owing to improvements in anesthesia and intensive care facilities. Over the last 15 years, minimally invasive techniques in radical cystectomy have evolved, with the aim of reducing morbidity. In this article, we review the development of laparoscopic radical cystectomy and robot-assisted radical cystectomy, along with current evidence on perioperative morbidity and medium-term oncological outcomes.