吡柔比星膀胱灌注预防膀胱癌术后复发的长期疗效观察

目的：总结吡柔比星（THP）膀胱腔内灌注预防膀胱癌术后复发的长期疗效和安全性。方法：回顾性分析1998年6月-2003年6月间209例膀胱尿路上皮癌患者术后膀胱内灌注THP预防肿瘤复发的临床资料：男171例，女38例，中位年龄63岁。按WHO和UICC分期和分级，Ta74例，T1 110例，T2a 25例；G1 52例，62134例，G3 23例。THP灌注方法为30mg／次，每周1次连用8次，以后每月1次连用8次，每次膀胱内保留30min。结果：192例患者获得随访，随访期60-120个月，中位数90个月。患者2、5年肿瘤复发率分别为19.7％（38/192）和23.9％（46／192），5年内复发患者肿瘤分级和分期进展率为19.6％（9／46）。80.2％膀胱癌患者灌注治疗后无明显副反应或出现轻度膀胱局部症状，但3.6％患者出现Ⅲ度局部副反应；全身副反应率仅为3.1％，表现为I-Ⅱ度，未见Ⅲ-Ⅳ度副反应。结论：THP用于膀胱癌术后灌注治疗预防肿瘤复发的长期疗效满意，治疗副反应以膀胱局部症状为主，安全性好。

Observation of Long-term Efficacy of Intravesical Instillation of Pirarubicin for Prevention from Recurrences in Patients with Bladder Carcinoma

Objective： To evaluate the long-term effect and safety of intravesical instillation of pirarubicin （THP）for prevention from recurrence in patients with bladder carcinoma. Methods：Clinical data of 209 patients with bladder carcinoma received postoperative prophylactic intravesical instillation of pirarubicin were retrospec-tively analysed. The median age of these patients is 63, with 171 males and 38 females. According to the WHO and UICC stage and grade system, 74 patients had their tumor classified as Ta, 110 as T1 and 25 as T2a, 52 patient as G1, 134 as G2 and 23 as G3. Intravesical instillation of THP was given at a dose of 30 mg every week for 8 consecutive weeks then every month for 8 months, the retention time in bladder was 30min. Results：Follow-up data were available in 192 patients with a median follow-up time of 90（60-120） months. The 2 and 5-year recur-rence rate is 19.7%（38/192） and 23.9%（46/192） respectively. Among the patients with recurrence, 19.6%（9/46） had higher tumor grade. 80.2% of the patients had no overt side effects or only had mild irritating symptom, while 3.6% experienced grade 3 local side effects. 3.1% of the patients had systemic side effect with all being grade 1 and 2, no effect with grade 3 and 4. Conclusions： Postoperative prophylactic intravesical instillation of pirarubicin to preventive recurence of bladder carcinoma is effective and safe, the side effects of treatment are mainly local bladder symptoms.