膀胱癌根治术前单次动脉灌注化疗的长期疗效评估

doi:10.3969/j.issn.1006-7795.2018.03.019

摘要/Abstract

摘要： 目的评估腹腔镜膀胱癌根治（laparoscopic radical cystectomy，LRC）术前单次新辅助动脉灌注化学药物治疗（以下简称化疗）对长期预后的影响。方法回顾性分析2006年2月至2015年12月间于首都医科大学附属北京朝阳医院行LRC术前26例单次动脉灌注化疗的患者围术期临床资料和随访结果。结果 26例患者LRC术前2~4周内行动脉灌注化疗，其中回肠膀胱9例，原位回肠新膀胱15例，输尿管皮肤造口2例，无中转开放。平均手术时间373 min （210~600 min），平均术中出血量为407 mL （100~1 400 mL）。术后病理提示均为尿路上皮癌，6例低级别，20例高级别，切缘均未见肿瘤。7例临床分期与病理分期相符，降期17例，升期2例，与术前临床分期相比，单次动脉灌注化疗局部降期效果显著（P=0.002）。平均淋巴结清扫数目17个（8~28个），8例淋巴结阳性。术后30 d内的合并症发生率在低级别和高级别肿瘤之间差异无统计学意义（P=0.081）。术后30 d内，30至90 d内以及超过90 d Clavien 3级以上合并症分别为3例、1例和2例。平均随访时间88个月（2~121个月），肿瘤特异性死亡2例，其他原因死亡1例，其中低级别和高级别肿瘤之间的总生存率（P=0.746）和肿瘤特异性生存率（P=0.446）差异均无统计学意义。结论 LRC术前进行单侧动脉灌注化疗并没有明显增加术后合并症，且同时起到显著地降期降级作用，但在肿瘤学预后方面还需要随机对照研究进行评估。

关键词: 膀胱癌, 动脉灌注化疗, 预后

Abstract: Objective Evaluation of long-term outcome of one-shot intra-arterial chemotherapy as new adjuvant therapy before laparoscopic radical cystectomy(LRC).Methods We retrospectively analyzed the preoperative clinical data and follow-up results of 26 patients who received one-shot intra-arterial chemotherapy before LRC in Urology Department of Beijing Chaoyang Hospital from February 2006 to December 2015.Results All patients were performed one-shot intra-arterial chemotherapy 2-4 weeks before the LRC and completed laparoscopic procedure without open conversion (ileal conduit urinary diversion for 9 patients, orthotopic ileal neobladder for 15 patients and cutaneous ureterostomy for 2 patients). The average operation time was 373 min (210-600 min) with estimated blood loss of 407 mL (100-1 400 mL). All pathology was urothelial cell carcinoma of the urinary bladder with 6 low grade and 20 high grade. No positive surgical margins were reported. Compared with clinical TNM stages, pathological TNM stages demonstrated significant decrease (P=0.002):7 cases had no changed, 17 cases achieved a stage decrease, and 2 cases had risen. The average lymph node number was 17 (8-28) including 8 positive cases. There was no statistical difference in 30-day postoperative complications between the low grade and high grade tumor (P=0.081). The number of Clavien level 3 or higher complications within 30 day, 30 to 90 days, and more than 90 days were 3 cases, 1 case and 2 cases, respectively. The patients were followed up for 88 months (2-121 months). There were two cancer-specific deaths and one died of other causes during the follow-up period; however, no difference was found in terms of overall survival (P=0.746) and cancer specific survival(P=0.446) between the low grade and high grade tumor.Conclusion With long-term follow-up, one-shot intra-arterial chemotherapy did not significantly increase the post-operative complications, at the same time significantly decreased the pathological stage and grade. Randomized trials will be required to better assess the oncology outcome.

Key words: bladder cancer, intra-arterial chemotherapy, outcomes

中图分类号:

R737.14

瓦斯里江·瓦哈甫, 刘赛, 王梦童, 贺庆豹, 宋黎明, 平浩, 王明帅, 杨飞亚, 田溪泉, 牛亦农, 邢念增. 膀胱癌根治术前单次动脉灌注化疗的长期疗效评估[J]. 首都医科大学学报, 2018, 39(3): 418-422.

Wasilijiang·Wahafu, Liu Sai, Wang Mengtong, He Qingbao, Song Liming, Ping Hao, Wang Mingshuai, Yang Feiya, Tian Xiquan, Niu Yinong, Xing Nianzeng. Long-term efficacy of one-shot intra-arterial chemotherapy before radical cystectomy[J]. Journal of Capital Medical University, 2018, 39(3): 418-422.

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