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.

A meta-analysis of the prognosis of comprehensive bladder preservation surgery and radical cystectomy for muscle-invasive bladder cancer

Objective To compare the prognosis of bladder preservation surgery+postoperative chemotherapy with that of radical cystectomy in patients with muscle-invasive bladder cancer. Method Controlled trials that compare blad-der preservation surgery+postoperative chemotherapy with radical cystectomy in patients with muscle-invasive bladder cancer were retrieved, with the 5-year postoperative survivals compared and odds ratio (OR) and 95%confidence interval (95%CI) calculated. Result 7 trials (876 patients in total) were included. The meta-analysis results showed that:one tri-al had an OR of 1.03 and a 95%CI of 1.03 (0.52~2.02);in four other trials, the corresponding OR and 95%CI were all<1;OR and 95%CI of the remaining two trials were>1;the total OR of the 7 trials was 1.05, and the 95%CI was 1.05 (0.53~2.06), suggesting no statistical difference in prognosis existing between comprehensive bladder preservation thera-py and radical cystectomy (Z=0.13, P=0.89). Conclusion For some patients with muscle-invasive bladder cancer, the comprehensive bladder preservation therapy does not reduce the 5-year survival rate, can retain normal bladder function, and improve quality of life. However, the indications should be carefully considered.