冬凌草热疗预防高危非肌层浸润性膀胱癌复发的临床疗效研究

发布时间：2018-06-07 09:57

  本文选题：膀胱癌 + 丝裂霉素-C　； 参考：《郑州大学》2017年硕士论文

【摘要】：研究目的探讨膀胱肿瘤术后冬凌草膀胱热灌治疗在预防高危非肌层浸润性膀胱癌复发方面的有效性及安全性,为临床诊疗提供有力证据。研究对象和方法回顾性分析我院2013年1月—2016年1月收治的高危非肌层浸性膀胱癌(NMIBC)患者80例,均在行经尿道膀胱肿瘤电切术(TURBt)或膀胱部分切除术后,经病理报告证实为尿路移行上皮细胞癌,病理分期为非肌层浸润性癌。术前患者心、肺、肝、肾功能和血常规检查无明显异常。按照患者或其家属的意见,患者术后分为两组,冬凌草热灌注组为A组40例,男30例,女10例,年龄34-97岁,均值63岁;术后病理回示Tis 3例,Ta期13例,T1期24例;病理分级按照WHO 2004膀胱尿路上皮癌恶性程度分级系统,低级别尿路上皮癌9例,高级别尿路上皮癌31例;肿瘤单发9例,多发31例;均行冬凌草膀胱热灌注治疗。丝裂霉素灌注组为B组共40例,男31例,女9例;年龄22-78岁,均值57岁;术后病理回示Tis 3例,Ta 10例,T1 27例;病理分级低级别尿路上皮癌8例,高级别尿路上皮癌32例;肿瘤单发14例,多发26例,术后均行丝裂霉素膀胱灌注化疗辅助治疗。综合两组患者的临床材料和病理结果,统计学分析其构成差别无显著性(P0.05)。术后对纳入研究的病例进行随访,统计两组病人在随访观察期间复发率、进展率及不良反应发生状况,评价该方法的临床安全性及有效性。结果随访3-45个月,中位时间16个月,未出现由于严重不良反应而退出研究的患者。A组复发率为32.5%(13/40),B组复发率为55%(22/40),两组复发率差异有显著性(χ2=4.11,P=0.0430.05),A组复发率显著低于B组。A组进展率为17.5%(7/40),B组进展率为37.5%(15/40),两组进展率差异亦有显著性(χ2=4.013,P=0.0450.05),A组进展率显著低于B组。根据患者膀胱癌复发时间的分布,通过Kaplan-Meier分析两组患者术后无复发生存率,A、B组的中位未复发期分别为34个月和23个月,两组肿瘤未复发率比较有统计学差异(log-rank检验χ2=4.11,P=0.040.05)。两组患者在治疗过程的不良反应主要有膀胱炎(表现为尿频、尿急、尿痛等膀胱刺激症状)、肉眼及镜下血尿、膀胱痉挛疼痛,未出现严重的并发症患者。A组治疗后不良反应共计8例,B组不良反应共计10例,两组比较差异无显著性(χ2=0.28,P0.05)。冬凌草液热疗可以有效的预防高危NMIBC术后复发与进展。结论膀胱肿瘤术后冬凌草膀胱热灌注治疗作为新的术后辅助治疗,用于预防膀胱肿瘤复发安全有效。相比以往常温下MMC灌注化疗,该方法的复发率和进展率都较低,且不增加不良反应发生率。故认为对于高危NMIBC患者,术后冬凌草膀胱热灌注预防肿瘤复发效果理想,值得临床推广。
[Abstract]:Objective to investigate the efficacy and safety of oridox in preventing the recurrence of high risk non-myometrial invasive bladder cancer after operation of bladder neoplasms, and to provide strong evidence for clinical diagnosis and treatment. Participants and methods A retrospective analysis of 80 cases of high risk NMIBC patients with non-myogenic bladder cancer treated in our hospital from January 2013 to January 2016 was performed after transurethral resection of bladder tumor (TURBt) or partial cystectomy. It was confirmed by pathology as transitional epithelial cell carcinoma of urinary tract and non-myometrial invasive carcinoma. There were no significant abnormalities in heart, lung, liver, kidney function and blood routine examination before operation. According to the opinion of the patients or their families, the patients were divided into two groups: group A: group A (40 cases), male 30 cases, female 10 cases, age 34 to 97 years old, mean 63 years old, postoperative pathology showed 3 cases of Tis, 13 cases of stage T 1 and 24 cases of T 1 stage. According to the WHO 2004 classification system, 9 cases of low grade urothelial carcinoma, 31 cases of high grade urothelial carcinoma, 9 cases of single tumor and 31 cases of multiple tumors were treated with oridox bladder hyperperfusion. There were 40 cases in group B (male 31, female 9; age 22-78 years, mean 57 years), 3 cases with Tis, 10 cases with T 1, 27 cases with T 1, 8 cases with low grade urothelial carcinoma and 32 cases with high grade urothelial carcinoma. There were 14 cases of single tumor and 26 cases of multiple tumor. All patients were treated with mitomycin intravesical chemotherapy after operation. According to the clinical data and pathological results of the two groups, there was no significant difference in the constitution of the two groups (P 0.05). The recurrence rate, progression rate and adverse reaction of the two groups were analyzed and the clinical safety and effectiveness of the method were evaluated. Results the follow-up period was 3-45 months and the median time was 16 months. The recurrence rate of group A was 32.5% and the recurrence rate of group B was 55 22 / 40%. The recurrence rate of group A was significantly lower than that of group B. the rate of progression in group B was 37.515% -40%. There was a significant difference between the two groups (蠂 2 4.11P 0.0430.05 0. 05). The development rate of group A was significantly lower than that of group B (蠂 2 + 4.013). According to the distribution of recurrence time of bladder cancer, the median non-recurrence period in group A and B was 34 months and 23 months respectively by Kaplan-Meier analysis. There was significant difference between the two groups by log-rank test (蠂 ~ 2 4.11). The adverse reactions of the two groups were mainly cystitis (symptoms of bladder irritation such as frequency of urination, urinal pain, hematuria under naked eye and microscope, pain in bladder spasm, etc.) In group A, there were 8 cases of adverse reactions in group B and 10 cases in group B, there was no significant difference between the two groups (蠂 2 0.28 P 0.05). The thermotherapy of oridox can effectively prevent the recurrence and progress of high-risk NMIBC. Conclusion as a new adjuvant treatment of bladder tumor, oridox is safe and effective in preventing the recurrence of bladder tumor. The recurrence rate and progression rate of this method were lower than that of MMC infusion chemotherapy at normal temperature, and the incidence of adverse reactions was not increased. It is considered that for high risk NMIBC patients, the effect of oridox bladder hyperperfusion for preventing tumor recurrence is ideal and worthy of clinical promotion.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14
，

本文编号：1990777