膀胱部分切除联合术中放疗在肌层浸润性膀胱癌中的疗效探讨

目的 比较三种不同治疗策略在肌层浸润性膀胱癌(MIBC)中的疗效。方法 收集2010年2月至2012年2月在中国人民解放军东部战区总医院拟行手术治疗的膀胱癌病人的临床资料。入组病人根据治疗方案分为膀胱部分切除组(A组)、膀胱癌根治组(B组)和膀胱部分切除+术中放疗组(C组)。比较三组病人的基线资料、手术及肿瘤相关指标、术后复发率、生存质量及5年生存率。结果 该研究共纳入病人109例,其中A组35例,B组41例,C组33例。三组病人手术时间、术中出血、住院时间比较差异有统计学意义,且三个指标均为A组最低,C组最高(P<0.05)；B组病人SF-36评分为(97.3±18.7)分显著低于A、C组病人(P<0.05)；A组病人肿瘤复发率(68.6%)显著高于B、C组(P<0.05)；A组病人的5年生存率(40.0%)显著低于B、C组(P<0.05),而B、C两组间差异无统计学意义(P>0.05)。结论 膀胱部分切除联合术中放疗术后复发率、5年生存率与膀胱癌根治术相当,但可提高病人术后生存质量。

Efficacy of partial cystectomy combined with intraoperative radiotherapy in muscle-invasive bladder cancer

Objective To analyze the efficacy of three different therapeutic strategies in patients with muscle-invasive bladder cancer.Methods Clinical data of patients with muscle-invasive bladder cancer received surgery treatment at Jinling Hospital from February 2010 to February 2012 were retrospectively analyzed.Patients were assigned into three groups according to the therapeutic schemes:partial cystectomy group (group A),radical cystectomy group (group B) and partial cystectomy combined with intraoperative radiotherapy group (group C).The baseline information,operation and tumor related indexes,postoperative recurrence rate,survival quality and the 5-year survival rate among three groups were compared.Results A total of 109 patients were included in the study,of whom 35 were in group A,41 in group Band 33 in group C.There were significant differences in the operation time,blood loss during the operation and length of hospital stay among three groups,and the lowest levels of all the three indexes were found in group Aand the highest found in group C (P<0.05).The SF-36 score in group B (97.3±18.7) was significantly lower than that in group Aand group C (P<0.05).Patients in group Ahad a higher postoperative recurrence rate (68.6%) and lower 5-year survival rate (40.0%) than group Band group C (P<0.05).The 5-year survival rates between group Band Cwere not significantly different.Conclusions Partial cystectomy combined with intraoperative radiotherapy had similar postoperative recurrence rate and 5-year survival rate to radical cystectomy but with a better life quality.