膀胱灌注表阿霉素预防表浅性膀胱癌术后复发的系统评价

目的评价膀胱灌注表阿霉素预防表浅性膀胱癌术后复发的疗效和副作用.方法按文内所述纳入标准,参考Cochrane协作网工作手册,计算机检索Medline(1966～2002.9)、EMbase(1985～2002)、Cochrane Library(2002年第4期)和中国生物医学文献光盘数据库(CBMdisc,1970～2002);手工检索发表或未发表的文献,包括<中华泌尿外科杂志>等12种杂志、中华泌尿外科学会组织的学术会议论文集(1990～2002)、美国AUA(1995～2002)、欧洲ECCO会议论文集(1995～2002)和北京大学等3所大学学位论文汇编等.文献资料用统一的表格由两名评价者独立进行提取,采用Jadad质量计分法评价文献质量,并应用Rev-man 4.2软件进行数据处理与分析.结果共检索到文献213篇,经排查后,符合纳入标准并进入系统评价的文献共10篇,其中3篇属于高质量RCT,其余为低质量RCT.Meta分析结果显示:表阿霉素膀胱灌注加手术治疗与单纯手术比较,在1年未复发方面,RR合并=1.51,95%CI(1.32,1.72);在2年未复发方面,RR合并=1.49,95%CI(1.35,1.66);剂量＜50 mg/次的表阿霉素膀胱灌注,在术后复发预防方面,RR合并=1.34,95%CI(1.22,1.48);剂量＞50 mg/次的表阿霉素膀胱灌注,在术后复发预防方面,RR合并=1.63,95%CI(1.48,1.79);单次阿霉素膀胱灌注的术后1年未复发率,RR=1.49,95%CI(1.33,1.66),术后2年未复发率,RR=1.58,95%CI(1.36,1.84);表浅性膀胱癌术后疾病进展率:RR-0.79,95%CI(0.53,1.17);阿霉素膀胱灌注后的总副作用发生率:RR=4.34,95%CI(2.62,7.19).结论不同剂量的表阿霉素膀胱灌注均可降低表浅性膀胱癌术后复发率;单次表阿霉素膀胱灌注可以降低表浅性膀胱癌术后复发率,但应谨慎选择病例;表阿霉素膀胱灌注对表浅性膀胱癌病情进展没有影响;表阿霉素膀胱灌注可引起一些副作用,但可以耐受,不影响患者正常生活.

A Systematic Review of Epirubicin for Prevention of Postoperative Recurrence of Superficial Bladder Cancer

ObjectiveTo assess the efficacy and the treatment-induced side effects of intravesically administered Epirubicin (EPI) following TUR in patients with Ta and T1 superficial bladder cancer compared to TUR alone. Methods According to the Cochrane reviewer's handbook, included studies were those on patients with histologically confirmed Ta and T1 bladder cancer. EPI and EPI derivatives, dose and schedule would be considerd appropriate for inclusion. The search strategy was developed according to the Collaborative Review Group search strategy. Medline, EMbase, CBMdisc and the Cochrane library, articles of conference proceedings, and academic collections were searched for randomised controlled trials (RCTs) and quasi-RCT comparing intravesical EPI following TUR with TUR alone. Data were extracted from each identified paper independently by two reviewers. Trials were assessed for quality according to the method of Jadad scale. RevMan4.2 software developed by the Cochrane Collaboration was used for satistical analysis.Results Two hundred and thirteen related articles were identified, but only 10 were included in our systematic review. 3 articles were high quality and the rest were low. The pooled RR=1.51 (95%CI 1.32 to 1.72) and the pooled RR=1.49 (95%CI 1.35 to 1.66) in patients with Ta and T1 bladder cancer at 1 and 2 years respectively; The pooled RR=1.34 (95%CI 1.22 to 1.48) when comparing relative efficacy of intravesical EPI (drug dose<50mg) following TUR with TUR alone; The pooled RR=1.63 (95%CI 1.48 to 1.79) when comparing relative efficacy of intravesical EPI (drug dose>50 mg) following TUR with TUR alone. RR=1.49 (95%CI 1.33 to 1.66) and RR=1.56 (1.36,1.84) when comparing relative efficacy of single intravesical EPI following TUR with TUR alone respectively. RR=0.79 (95%CI 0.53 to 1.17) when comparing the incidence of disease progression of intravesical doxorubicin following TUR with TUR alone. RR=4.34 (95%CI 2.62 to 7.19) when comparing side effect of intravesical EPI following TUR with TUR alone.Conclusion Intravesically administered EPI following TUR in patients with Ta and T1 superficial bladder cancer may reduce the incidence of tumour recurrence, but cannot reduce the incidence of disease progreesion. Intravesically administered EPI following TUR has some side effects but can be tolerated and has no influence on the life of patients.