浸润性膀胱癌保留膀胱综合治疗的短期疗效分析

目的:探讨T2N0M0 、T3N0M0原发性浸润性膀胱癌三种不同治疗方案的近期临床疗效.方法:134例原发性浸润性膀胱癌患者,按术式分为3组,单纯治疗组(S组) 56例行单纯保留膀胱手术,术后常规行丝裂霉素或羟基喜树碱膀胱灌注6个月以上,其中T2N0M0 28例,T3N0M0 28例;综合治疗(I组) 37例行保留膀胱手术、术后行静脉吉西他滨和顺铂化疗,并常规行丝裂霉素或羟基喜树碱膀胱灌注6个月以上,其中T2N0M0 16例,T3N0M0 21例;根治组(R组)41例行根治性手术,其中T2N0M0 20例,T3N0M0 21例.比较3组患者的三年总体生存率以及相同临床分期患者的三年生存率.结果:S组三年总体生存率为39.29%,T2N0M0患者三年生存率为42.86%,T3N0M0为39.26%;I组三年总体生存率为70.27% 、T2N0M0患者三年生存率为75.00%、T3N0M0为66.67% ;R组三年总体年生存率为75.61%,T2N0M0患者三年生存率为80.00%,T3N0M0为71.24%.S组与I组间三年生存率比较差异有统计学意义(P＜0.05),I组与R组间比较差异无统计学意义(P＞0.05).结论:T2N0M0 、T3N0M0临床分期的原发性浸润性膀胱癌患者,综合治疗与根治治疗近期临床疗效无统计学差异.因此建议采用保留膀胱的综合方法治疗,以提高患者生活质量.

Short Term Curative Effect on Combined Therapy with Bladder Preservation for Invasive Bladder Cancer

Objective： To explore the clinical effects of three different treatments for T2NoMo and T3NoMo primary invasive bladder cancer. Mcthods：134 cases of primary invasive bladder cancer were random- ly divided into three groups. 56 cases with bladder preservation surgery alone were grouped into S group （simple group） ： T2 No Mo 28 cases and T3 NO Mo 28 cases, routine postoperative instillation of mitomycin or HCPT for 6 months or more . 37 patients underwent bladder preservation surgery, postoperative chemotherapy with gemcitabine and cisplatin in patients were grouped into I group （integrated group） ： T2 No Mo 16 cases and T3 NO Mo 21 cases, after the bladder preservation surgery , routine postoperative instillation of mitomycin or HCPT for 6 months or more and postoperative intravenous chemotherapy （chemotherapy： gemeitabine and cisplatin ）. 41 patients underwent radical surgery were grouped into R group （radical group） ：T2 No Mo 20cases and T3 NO M0 21 cases. The 3 - year overall survival with three groups and clinical stage of the same 3 - year survival rates were compared. Results：The 3 -year overall survival rate in S group and the various clinical stages of 3 -year survival rate were 39.29% , T2NoMo 42.86% , T3NoM0 39.26% ; the 3 - year overall survival rate in I group and different clinical stages 3 - year survival rate were 70.27%, T2NoMo 75.00%, T3NoMo 66.67% ; the 3 - year overall survival rates in R group and different clinical stages 3 -year survival rate were 75.61%, T2NoM0 80.00% , T3 No Mo 71.24% ; The comparison of S group and I group was statistically significant （P 〈 0.05 ）, I group and R group was not statistically significant （ P 〉 0.05 ）. Conclusions ： About T2 No M0 and T3 No M0 primary invasive bladder cancer ,there is no different clinical efficacy between comprehensive therapy and radical surgery , the comprehensive therapy can retain the bladder, improve life quality of the patients and it is worth recommending.