吡柔比星与羟基喜树碱对浅表性膀胱癌的预防及安全性的meta分析

目的 比较吡柔比星(THP)与羟基喜树碱（HCPT）膀胱灌注对膀胱癌复发的预防作用及治疗毒性。方法 收集关于THP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。采用相对危险度(RR)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 5.3。结果 共入选18项临床研究包括1597名患者,其中822例接受THP治疗，775例接受HCPT治疗。Meta分析结果提示，THP组与HCPT组6个月复发率无统计学差异 RR =0.69，95% CI (0.47，1.02)， P >0.05]，9个月复发率无统计学差异 0R =0.80，95% CI (0.42，1.54)， P>0.05]，而THP组1年内复发率低于 HCPT 组 RR =0.74，95% CI (0.56，0.99)， P <0.05] ，2年内复发率也低于HCPT组 RR =0.74，95% CI (0.61，0.92)， P <0. 01]。两组间的膀胱刺激症状、血象无显著性差异 ( P 均>0.5)；两组膀胱灌注预防血尿发生率的差异有统计学意义 RR =1.74，95% CI (1.11，2.72) P =0.02]，羟基喜树碱组血尿发生率低于吡柔比星组。 结论： 吡柔比星与羟基喜树碱对肿瘤的复发率的控制灌注后约6、9个月无明显差异，而长期来看1年和2年THP的复发率小于HCPT，因此THP的控制效果优于HCPT：两者的不良反应中的膀胱刺激症状、血象异常（白细胞降低）无明显差异，而羟基喜树碱组血尿发生率低于吡柔比星组。在可以耐住不良反应的前提下，优选THP。

Meta-analysis on the Prevention and Safty of Pirarubicin and Hydroxycamptothecin in the Treatment of Superficial Bladder Cancer

OBJECTIVE To compare the preventive and therapeutic effects of intravesical instillation of pirarubicin (THP) and hydroxycamptothecin (HCPT) on recurrence of bladder cancer. METHODS A comparative study of THP and HCPT intravesical instillation for the treatment of bladder cancer was performed and analyzed systematically. Relative risk (RR) and 95% confidence interval (CI) were used to evaluate the efficacy and toxicity differences. The statistical software we used was RevMan 5.3. RESULTS A total of 18 clinical studies included 1597 patients,of which 822 received THP treatment,775 received HCPT treatment. Meta-analysis showed that there was no significant difference in recurrence rate between THP group and HCPT group RR = 0.69,95% CI (0.47,1.02), P> 0.05], and the recurrence rate was not statistically significant at 9 months 0R =0.80,95% CI (0.42,1.54),P>0.05]. The relapse rate in THP group was lower than that in HCPT group RR = 0.74, 95% CI (0.56, 0.99), P <0.05] Also lower than HCPT group RR = 0.74,95% CI (0.61,0.92), P <0.01]. There was no significant difference between the two groups in the symptoms of bladder irritation and hemogram (P> 0.5). There was significant difference in the incidence of urinary incontinence between the two groups RR = 1.74, 95% CI (1.11, 2.72) P = 0.02] The incidence of hematuria in the hydroxycamptothecin group was lower than that in the pirarubicin group. CONCLUSION There is no significant difference in the recurrence rate between pirarubicin and hydroxycamptothecin for about 6 and 9 months after infusion. In the long term, the recurrence rate of THP in one year and two years is less than that in HCPT, so the control effect of THP The incidence of hematuria in the HCPT group was lower than that in the pirarubicin group (P <0.05), but there was no significant difference between the two groups in the symptoms of bladder irritation and blood leukocyte (WBC). THP is preferred in that it is resistant to adverse reactions.