吉西他滨膀胱灌注治疗复发性浅表性膀胱肿瘤的安全性与有效性

目的 评价吉西他滨膀胱灌注化疗治疗常规膀胱灌注化疗(包括丝裂霉素、表阿霉素和羟基喜树碱)失败的非肌层浸润性膀胱癌(NMIBC)的安全性及有效性.方法 将72例在持续常规膀胱灌注化疗1年内出现肿瘤复发的NMIBC患者分为A、B、C 3组,每组24例.A组给予吉西他滨1000 mg灌洗,B组给予吉西他滨2000 mg灌洗,C组继续采用原化疗方案灌洗.观察并记录肿瘤复发时间及化疗不良反应.结果 A、B、c组患者的2年肿瘤无复发生存率分别为66.7%、75.0%和45.8%,采用吉西他滨灌洗患者的2年无瘤生存率达70.8%,显著高于传统化疗方案(45.8%,P<0.05),但A组与B组间未见明显差异.A组与B组中各有I例患者发生肾功能不全,其余不良反应主要为尿频、尿急、尿痛、血尿等,经对症治疗后缓解,各组间未见有明显差异,未发生严重的血液学不良反应.结论 对于常规膀胱灌注化疗后复发的NMIBC患者可考虑采用吉西他滨膀胱灌注化疗,但需注意观察患者的肾功能改变.     

吉西他滨膀胱灌注治疗复发性浅表性膀胱肿瘤的安全性与有效性

目的 评价吉西他滨膀胱灌注化疗治疗常规膀胱灌注化疗(包括丝裂霉素、表阿霉素和羟基喜树碱)失败的非肌层浸润性膀胱癌(NMIBC)的安全性及有效性.方法 将72例在持续常规膀胱灌注化疗1年内出现肿瘤复发的NMIBC患者分为A、B、C 3组,每组24例.A组给予吉西他滨1000 mg灌洗,B组给予吉西他滨2000 mg灌洗,C组继续采用原化疗方案灌洗.观察并记录肿瘤复发时间及化疗不良反应.结果 A、B、c组患者的2年肿瘤无复发生存率分别为66.7%、75.0%和45.8%,采用吉西他滨灌洗患者的2年无瘤生存率达70.8%,显著高于传统化疗方案(45.8%,P<0.05),但A组与B组间未见明显差异.A组与B组中各有I例患者发生肾功能不全,其余不良反应主要为尿频、尿急、尿痛、血尿等,经对症治疗后缓解,各组间未见有明显差异,未发生严重的血液学不良反应.结论 对于常规膀胱灌注化疗后复发的NMIBC患者可考虑采用吉西他滨膀胱灌注化疗,但需注意观察患者的肾功能改变.     

经尿道膀胱肿瘤电切术与不同化疗药物联合治疗非肌层浸润性膀胱癌的疗效观察

目的 探讨经尿道膀胱肿瘤电切术(TURBT)与不同化疗药物联合治疗非肌层浸润性膀胱癌(NMIBC)的临床效果.方法 选取2017年8月至2019年8月间河南大学淮河医院收治的行TURBT治疗的62例NMIBC患者,采用随机数字表法分为研究组和对照组,每组31例.研究组患者术后6h内行吡柔比星膀胱热灌注治疗,对照组患者术...     

新辅助与辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效对比

 目的 探讨经尿道膀胱肿瘤电切术（TURBT）术前新辅助膀胱热灌注化疗对比术后辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效。方法 收集经尿道膀胱肿瘤电切术术前或术后使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌患者40例,其中16例行术前（吉西他滨1000 mg,45℃,45 min）新辅助膀胱热灌注化疗3次,隔天一次,治疗结束后3~7天行经尿道膀胱肿瘤电切术,定义为新辅助组;另外24例患者先行TURBT手术,术后即刻或者隔天（吉西他滨1000 mg,45℃,45 min）行辅助膀胱热灌注化疗,定义为辅助组。记录并比较两组患者无疾病复发生存期（RFS）以及不良反应。结果 全部40例患者均完成3次吉西他滨膀胱热灌注化疗,新辅助组患者中,完全缓解（pT0）11例（68.8%）,部分缓解5例（31.2%）。新辅助组中位无复发生存期为54月,辅助组中位无复发生存期为45月,两者比较差异无统计学意义（P=0.3146）。两组患者不良反应可耐受。结论 无论是新辅助还是辅助治疗,使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌安全有效。     

经尿道膀胱肿瘤电切术后吉西他滨+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后吉西他滨+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 根据化疗药物的不同将97例非肌层浸润性膀胱癌患者分为观察组（n=50）和对照组（n=47）,观察组患者经尿道膀胱肿瘤电切术后给予吉西他滨+表柔比星灌注化疗,对照组患者术后给予表柔比星灌注化疗。比较两组患者的临床疗效、Dickkopf相关蛋白1(DKK-1)水平、人类软骨糖蛋白39(YKL-40)水平、不良反应发生情况和预后情况。结果 观察组患者的治疗总有效率为86.00%,高于对照组患者的68.09%,差异有统计学意义（P﹤0.05）。治疗后,两组患者DKK-1、YKL-40水平均低于本组治疗前,且观察组患者DKK-1、YKL-40水平均低于对照组,差异均有统计学意义（P﹤0.05）。观察组患者不良反应总发生率为16.00%,与对照组患者的10.64%比较,差异无统计学意义（P﹥0.05）。随访1年,观察组患者的总生存率为88.00%,明显高于对照组患者的55.32%,差异有统计学意义（P﹤0.01）。结论 经尿道膀胱肿瘤电切术后吉西他滨+表柔比星灌注化疗能够有效改善临床疗效,降低DK...     

卡介苗、铜绿假单胞菌交替膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的疗效及安全性

目的:分析卡介苗(bacillus calmette guerin, BCG)、铜绿假单胞菌(pseudomonas aeruginosa, PA)-MSHA菌毛株交替膀胱灌注对高危非肌层浸润性膀胱癌(non-muscular invasive bladder cancer, NMIBC)术后患者的肿瘤复发率、不良反应及灌注前后患者生活质量的影响。方法:回顾性分析我科自2017年10月至2019年10月收治的120例诊断为膀胱癌并行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT),且术后病理提示为高危NMIBC的患者。随机分为两组,分别为BCG、PA-MSHA交替灌注组(实验组,60例)及吉西他滨单药灌注组(对照组,60例)。术后2年不同阶段对患者进行随访,针对两组患者治疗后肿瘤复发率、不良反应及灌注前后对患者生活质量的影响进行比较分析。结果:经过术后12个月的灌注治疗,两组患者肿瘤复发率比较无统计学差异（P> 0.05）;灌注18个月及24个月,实验组肿瘤复发率（11.67%、15.00%）均低于对照组（26...     

吉西他滨膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的疗效观察

目的观察吉西他滨膀胱灌注预防高危非肌层性浸润膀胱癌术后复发的疗效。方法90例高危非肌层浸润性膀胱癌经尿道膀胱肿瘤电切(TURBt)术后患者随机分为两组,每组45例,分别采用吉西他滨(治疗组)和吡柔比星(对照组)膀胱灌注。术后定期行膀胱镜检查,观察两组患者肿瘤复发情况及不良反应。结果治疗组患者随访期间有7例复发,总复发率为15.5%;对照组患者随访期间有16例复发,总复发率为35.5%,两组差异有统计学意义(P<0.05)。治疗组发生不良反应10例,对照组发生不良反应9例,主要为尿频、尿急、尿痛和血尿等,对症治疗后缓解,两组患者均未发生严重不良反应。结论 TURBt术后膀胱灌注吉西他滨预防高危非肌层浸润性膀胱癌术后复发的疗效确切,患者耐受性好,是较理想的膀胱灌注化疗药。     

吉西他滨膀胱灌注治疗复发性浅表性膀胱肿瘤的安全性与有效性

目的 评价吉西他滨膀胱灌注化疗治疗常规膀胱灌注化疗(包括丝裂霉素、表阿霉素和羟基喜树碱)失败的非肌层浸润性膀胱癌(NMIBC)的安全性及有效性.方法 将72例在持续常规膀胱灌注化疗1年内出现肿瘤复发的NMIBC患者分为A、B、C 3组,每组24例.A组给予吉西他滨1000 mg灌洗,B组给予吉西他滨2000 mg灌洗,C组继续采用原化疗方案灌洗.观察并记录肿瘤复发时间及化疗不良反应.结果 A、B、c组患者的2年肿瘤无复发生存率分别为66.7%、75.0%和45.8%,采用吉西他滨灌洗患者的2年无瘤生存率达70.8%,显著高于传统化疗方案(45.8%,P<0.05),但A组与B组间未见明显差异.A组与B组中各有I例患者发生肾功能不全,其余不良反应主要为尿频、尿急、尿痛、血尿等,经对症治疗后缓解,各组间未见有明显差异,未发生严重的血液学不良反应.结论 对于常规膀胱灌注化疗后复发的NMIBC患者可考虑采用吉西他滨膀胱灌注化疗,但需注意观察患者的肾功能改变.

Abstract：

Objective To evaluate the efficacy and safety of intravesical instillation with gemcitabine after first-line intravesical chemotherapy failure, including mitomycin ( MMC), epirubicin (EPB) and camptothecin- (CPT), in the treatment of non-muscle-invasive bladder cancer (NMIBC). Methods From June 2007 to October 2008, 72 patients with NMIBC, who had tumor recurrence within one year of first-line intravesical chemotherapy, were assigned to 3 groups (24 cases each). Croup A received intravesical gemcitabine in a dose of 1000 mg, Group B received 2000 mg gemcitabine, and Group C received original intravesical chemotherapy. The time of reccurrence and adverse effects were recorded. Results The 2-year tumor free survival rates of the 3 groups were 66.7% , 75.0% and 45.8% , respectively. The 2-year TFS rate of the patients who received gemcitabine was 70.8% , significantly higher than 45.8% of the patients treated by original chemotherapy. There was one case with renal function impairement in the groups A and B, respectively. There was no significant difference between the rates of low urinary tract symptoms in the 3 groups. No severe hematological side effects were observewd in this study. Conclusion The intravescal chemotherapy with gemcitabine in patients with recurrent bladder tumor after first-line intravesical chemotherapy is effective and well tolerated, however, renal function should be routinely assessed.     

吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的效果观察

目的 探讨吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的效果.方法将80例初发非肌层浸润性膀胱癌患者分为试验组(40例)和对照组(40例).2组患者均行经尿道膀胱肿瘤切除手术(TURBT).对照组于术后行羟喜树碱膀胱灌注,试验组采用吉西他滨联合羟喜树碱膀胱灌注.定期对患者进行随访,时间为5年,观察对比2组患者术后6个月、术后1年、术后2年、术后3年和术后5年的复发率和进展率,以及不良反应发生情况.结果治疗后,试验组和对照组在术后6个月、术后1年和术后2年的复发率方面不具有统计学差异(P均>0.05),但是在术后3年和术后5年的复发率方面差异具有统计学意义(P<0.05);术后5年2组的进展率具有统计学意义(P<0.05).试验组不良反应发生率与对照组相比,差异具有统计学意义(P<0.05).结论采用吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发和单纯采用羟喜树碱防治的近期效果相近,但是远期效果显著,值得推广.     

短周期二次经尿道膀胱肿瘤电切术联合化疗治疗T2期膀胱尿路上皮癌的临床分析

目的探讨短周期二次经尿道膀胱肿瘤电切术联合术后化疗治疗T2期肌层浸润性膀胱癌的临床疗效。方法选取84例T2期膀膀胱尿路上皮癌患者,依据治疗方法分为观察组(n=41)和对照组(n=43)。两组患者均接受常规诊断性经尿道膀胱肿瘤电切术(TURBT),对照组患者予以常规根治性膀胱切除术+盆腔淋巴结清扫术+尿流改道,观察组患者于第一次常规诊断性TURBT术后4~6周再次行TURBT,两组患者术后均予以辅助吉西他滨+顺铂(GC方案)化疗。比较两组患者的手术相关指标、并发症发生率、复发情况和生存情况。结果观察组患者术中出血量明显低于对照组患者,手术时间、住院时间均明显短于对照组患者,差异均有统计学意义(P﹤0.01)。观察组患者术后并发症发生率9.76%(4/41),与对照组患者并发症发生率6.98%(3/43)比较,差异无统计学意义(P﹥0.05)。观察组患者复发转移率35.90%(14/39),与对照组患者的25.00%(10/40)比较,差异无统计学意义(P﹥0.05)。对照组患者1年总生存率90.00%(36/40),3年总体生存率65.00%(26/40),与观察组患者1年总生存率87.18%(34/39),3年总生存率58.97%(23/39)比较,差异均无统计学意义(P﹥0.05)。结论短周期二次经尿道膀胱肿瘤电切术联合化疗是一种治疗T2期膀胱尿路上皮癌安全有效的治疗方案。     

Tumor markers of bladder cancer: the schistosomal bladder tumors versus non-schistosomal bladder tumors

Recent data have redefined the concept of inflammation as a critical component of tumor progression. However, there has been little development on cases where inflammation on or near a wound and a tumor exist simultaneously. Therefore, this pilot study aims to observe the impact of a wound on a tumor, to build a new mouse tumor model with a manufactured surgical wound representing acute inflammation, and to evaluate the relationship between acute inflammation or wound healing and the process of tumor growth. We focus on the two phases that are present when acute inflammation influences tumor. In the early phase, inhibitory effects are present. The process that produces these effects is the functional reaction of IFN-γ secretions from a wound inflammation. In the latter phase, the inhibited tumor is made resistant to IFN-γ through the release of TGF-β to balance the inflammatory factor effect on the tumor cells. A pair of cytokines IFN-γ/TGF-β established a new balance to protect the tumor from the interference effect of the inflammation. The tumor was made resistant to IFN-γ through the release of TGF-β to balance the inflammatory effect on the tumor cells. This balance mechanism that occurred in the tumor cells increased proliferation and invasion. In vitro and in vivo experiments have confirmed a new view of clinical surgery that will provide more detailed information on the evaluation of tumors after surgery. This study also provides a better understanding of the relationship between tumor and inflammation, as well as tumor cell attacks on inflammatory factors.     

Characteristics of bladder microcirculation in women with overactive bladder

We studied microcirculation and a blood nitric oxide level in 30 females aged 23-63 years with overactive bladder (OAB) before and after administration of oxibutinin. We found that OAB patients have microcirculation disorders accompanied with elevation of nitric oxide in the blood. Oxibutin improved bladder microcirculation, normalized blood nitric oxide with resultant positive changes in clinical symptoms with less frequent voiding and alleviation of imperative disorders.     

肌层浸润性膀胱癌保留膀胱手术的临床观察

目的　探讨肌层浸润性膀胱尿路上皮癌保留膀胱手术的有效性及安全性。方法　收集２００３年６月至２００７年６月行保留膀胱手术的４１例肌层浸润性膀胱癌患者的临床资料,其中行膀胱部分切除术（ＰＣ）２９例,行根治性经尿道膀胱肿瘤电切术（ＴＵＲＢＴ）１２例。采用吡柔比星３０ｍｇ／次膀胱灌注化疗,每周１次,共８次,继而每月１次,共持续１年。每３个月行膀胱镜检查１次,持续２年。结果　ＰＣ组术后１、３年无瘤生存率分别为８２８％（２４／２９）和５５.２％（１６／２９）,ＴＵＲＢＴ组分别为７５％（９／１２）和５０％（６／１２）,两组差异均无统计学意义（Ｐ＞０.０５）。ＰＣ组术后肿瘤复发率为３４.５％（１０／２９）,首次肿瘤中位复发时间为９.５个月;ＴＵＲＢＴ组术后肿瘤复发率为４１.７％（５／１２）,首次肿瘤中位复发时间为８.０个月,两组差异均无统计学意义（Ｐ＞０.０５）。结论　对于身体条件不能耐受或不愿接受根治性膀胱全切术的肌层浸润性膀胱癌患者,行保留膀胱手术联合术后化疗是一种可行的治疗方案。     

Multimodality bladder preservation therapy for muscle-invasive bladder tumors

The standard treatment for muscle-invasive bladder cancer in the United States is still radical cystectomy with pelvic lymph node dissection. An alternative to cystectomy is multimodality bladder preservation with thorough transurethral resection, chemotherapy, and radiation therapy. This report addresses several key issues to be considered when selecting patients for a multimodality treatment for invasive bladder cancer. Recent protocols incorporating various fractionation schemes for radiation and alternative chemotherapeutic agents are reviewed. Quality of life associated with bladder preservation after a multimodality approach is also discussed.     

羟基喜树碱膀胱灌注化疗预防膀胱癌术后复发

目的 探讨羟基喜树碱在膀胱癌术后膀胱灌注化疗预防肿瘤复发的效果。方法 52例膀胱恶性肿瘤患行膀胱部分切除术或羟尿道膀胱肿瘤电气化切除术后，采用羟基喜树碱20mg 生理盐水20mg膀胱灌注20次预防膀胱肿瘤复发。结果 随访1～6年，术后2年无复发，2年后复发6例，复发率11．5％。结论 膀胱癌术后羟基喜树碱膀胱灌注化疗预防肿瘤复发，疗效肯定副作用小。     

肌层浸润性膀胱癌保留膀胱综合治疗的疗效评价研究

目的 评价髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗综合治疗肌层浸润性膀胱癌的临床疗效.方法 比较64例采用髂内动脉灌注化疗(吡柔比星40 mg/m2、5-FU 1000 mg/m2、羟喜树碱30 mg/m2)+经尿道膀胱肿瘤电切术+膀胱内灌注化疗(综合治疗组)和62例采用经尿道膀胱肿瘤电切术+膀胱内灌注化疗(对照组)的肌层浸润性膀胱癌(T2N0M0期)患者经治疗后的肿瘤复发/转移率、死亡率及治疗相关不良反应的发生情况.结果 至随访截至日期,综合治疗组的无复发/转移率为93.75%(60/64),明显高于对照组的45.16%(28/62),差异有统计学意义(P=0);转移死亡率为3.13%(2/64),低于对照组的16.13%(10/62),差异有统计学意义(P=0.015);非膀胱癌死亡率为10.94%(7/64),与对照组的12.90%(8/62)相比,差异无统计学意义(P﹥0.05).结论 髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗的综合治疗方案,能够降低肌层浸润性膀胱癌(T2N0M0)患者肿瘤复发率和死亡率,不增加非癌性死亡风险,值得进一步探讨.     

Management of bladder cancer

Bladder cancer is a paradigm of malignancy, representing the spectrum from localized to metastatic disease, and manifesting varied histologic types, including transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma. Preclinical and clinical data suggest that a common stem cell of origin gives rise to the different histologic types and that these patterns are of clonal origin. Localized bladder cancer is managed optimally by transurethral resection, with or without adjuvant intravesical chemotherapy. Invasive cancer or relapsed superficial disease may require more radical surgery or radical radiotherapy. In recent years, the evolution of techniques of continent urinary diversion or of bladder replacement has revolutionized the management of invasive disease. However, the 5-year survival for invasive bladder cancer is still approximately 50%, and innovative strategies have been developed, combining definitive local treatment and systemic chemotherapy, in an attempt to improve survival. For patients with metastatic disease, the combination of methotrexate, vinblastine, doxorubicin, and cisplatin (the MVAC regimen) has achieved response rates as high as 70% but with a median survival of only 12 months. Until cure rates are improved, one of the hallmarks of effective management of metastatic disease will remain the provision of thorough and well-structured palliative treatment programs. Recently, the introduction of new agents (such as paclitaxel, gallium, ifosfamide, and gemcitabine) has led to promising response rates, and further clinical trials of these agents alone and in combination are in progress. In addition, an improved understanding of the mechanisms of resistance to treatment, including the implications of the expression of p-glycoprotein, p53 proteins, and other biochemical predictors of outcome, and of strategies to overcome such resistance, may lead to more effective management of advanced disease. Furthermore, real progress will be made only through the application of well-designed clinical trials to test the efficacy and toxicity of the new strategies of treatment.