非浸润性膀胱癌术后膀胱灌注化疗时间长短与疗效比较的系统评价

发布时间：2018-06-15 17:14

本文选题：浸润 + 膀胱癌　；参考：《华中科技大学》2014年博士论文

【摘要】：目的：对于TURBT术后维持膀胱灌注化疗时间对预防非浸润性膀胱癌复发和进展的影响进行比较方法学：为了比较这两种不同时长(半年以下与一年以上)灌注方法的优劣,几个较大的数据库(Medline, EMBASE, Web of Science及Cochrane Library data bases)均依次进行了检索。检索过程中,检索词均以主题词及自由词的参与检索。风险比(HR)及其95%可信区间作为统计量被用来评价膀胱肿瘤的复发率。我们使用了考克兰合作组织(Cochrane Collaboration)推荐的软件Revman5.2进行数据分析。对于风险比的计算,我们采用的是“实验组观察值-实验组期望值(0-E)”除以“方差(V)”的计算方法。为了减小异质性,我们分别采用了敏感性分析及亚组分析。最后,同样由考克兰合作组织推荐的GRADEpro3.6软件被用来做文章的质量评价。结果：该系统评价共纳入13个合格的临床随机对照试验(RCTs),包含4216名符合标准的患者及16个符合标准的分组对比。总的分析显示,长疗程术后膀胱灌注化疗与短疗程术后膀胱灌注化疗相比并未表现出优势[HR0.99,95%CI(0.89,1.11),P=0.89]。进一步的亚组分析显示：经尿道膀胱肿瘤切除术(TURT-BT)后24小时内完成即刻膀胱灌注化疗的病人,其长疗程灌注化疗效果较短疗程相比有一定优势[HR0.83,95%CI(0.69,1.00),P=0.05].不过,术后延迟膀胱灌注化疗的病人则无此差异；在药物方面,采用表柔比星(EPI)灌注的病人其长程灌注效果与短程灌注效果相比无明显优势[HR1.01,95%CI (0.90,1.15),P=0.82]；初发的膀胱肿瘤病人较复发肿瘤患者能够从长程灌注化疗中获得更大的益处[HR0.77,95%CI (0.63,0.94),P=0.01].但是,长程灌注化疗在预防肿瘤进展方面似乎作用不大[HR0.96,95%CI(0.66,1.39),P=0.82]. 结论：首先,肿瘤复发方面：对于接受即刻术后灌注化疗的患者和初发的肿瘤患者,一年以上的维持灌注化疗较半年以下相比能够进一步降低肿瘤的复发率；其他患者不能从半年以上的维持灌注治疗中进一步获益；使用表柔比星作为灌注药物时,同样不应超过半年。其次,肿瘤进展方面：一年以上的膀胱灌注较半年以下相比不能进一步预防肿瘤进展。再次,一年以上膀胱灌注并不会明显增加不良反应的发生。
[Abstract]:Objective: to compare the effects of maintaining the duration of intravesical chemotherapy after TURBT on the prevention of recurrence and progression of non-invasive bladder cancer: to compare these two different periods of time. (less than half a year and more than one year) the merits and demerits of the perfusion method, Several large databases, such as Medline, EMBASE, Web of Science and Cochrane Library data bases, were searched successively. In the process of retrieval, the key words are searched with the participation of the subject word and the free word. HRV and 95% CI were used as statistics to evaluate the recurrence rate of bladder tumors. We analyzed the data using Revman 5.2, a software recommended by Cochrane collaboration. For the calculation of risk ratio, we use the method of "experimental group observation value-experimental group expectation value 0-E)" divided by "variance V". In order to reduce heterogeneity, sensitivity analysis and subgroup analysis were used. Finally, Gradepro3.6, also recommended by Cochran, is used to evaluate the quality of the article. Results: the systematic evaluation included 13 eligible randomized controlled trials, including 4216 patients who met the criteria and 16 patients who met the criteria. The general analysis showed that there was no advantage in the long-term postoperative bladder infusion chemotherapy compared with the short-course postoperative bladder perfusion chemotherapy [HR0.99 ~ 95CI0.89 ~ (1.11) P ~ (0.89)]. Further subgroup analysis showed that patients who completed immediate intravesical chemotherapy within 24 hours after transurethral resection of bladder neoplasms had some advantages compared with shorter courses of chemotherapy [HR0.83C95CI0.691.00P0.05]. However, there was no difference in patients with delayed intravesical instillation after operation, but in the patients with epirubicin (EPI) perfusion, there was no significant difference between the long-term perfusion effect and the short-course perfusion effect [HR1.01C _ (95) CI 0.90 ~ 1.15P ~ (0.82)]. The primary bladder tumor patients could obtain more benefit from long term infusion chemotherapy than the patients with recurrent tumor [HR0.7795 CI 0.630.94P0. 01]. However, long term infusion chemotherapy seems to be of little effect in preventing tumor progression [HR0.966 ~ 95CI0.661.39]. Conclusion: first of all, tumor recurrence: for patients receiving immediate postoperative infusion chemotherapy and primary tumor patients, more than one year of maintenance infusion chemotherapy compared with less than half a year can further reduce the recurrence rate of tumor. Other patients could not benefit further from maintenance infusion for more than half a year; epirubicin should also not be used for more than half a year. Secondly, tumor progression: bladder perfusion for more than one year can not prevent tumor progression compared with less than half a year. Again, bladder perfusion for more than a year did not significantly increase the incidence of adverse reactions.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.14

【参考文献】