發(fā)布時(shí)間：2018-03-03 16:27

  本文選題：膀胱熱灌注化療　切入點(diǎn)：灌注化療　出處：《新鄉(xiāng)醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的比較膀胱熱灌注化療和灌注化療治療非肌層浸潤(rùn)性膀胱癌(Non-muscle-invasive Bladder Cancer,NMIBC)術(shù)后的優(yōu)缺點(diǎn),全面系統(tǒng)的評(píng)價(jià)兩種化療方式的臨床療效及安全性,為非肌層浸潤(rùn)性膀胱癌的臨床診療提供高質(zhì)量的證據(jù)。方法通過電子計(jì)算機(jī)檢索Cochrane圖書館、MEDLINE(通過PubMed檢索平臺(tái))、EMBASE(通過ovidsp檢索平臺(tái))、中國(guó)知網(wǎng)(CNKI)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、萬方數(shù)據(jù)庫(kù)(WanFang),收集膀胱熱灌注化療和膀胱灌注化療治療膀胱癌的臨床試驗(yàn)文獻(xiàn)研究,檢索時(shí)限至2015年10月15日。手工檢索1993年1月-2015年10月與膀胱腫瘤相關(guān)的幾種中文雜志:《現(xiàn)代泌尿生殖腫瘤雜志》、《國(guó)際泌尿系統(tǒng)雜志》、《中華泌尿外科雜志》、《臨床泌尿外科雜志》等。由2位獨(dú)立的評(píng)價(jià)者參照Cochrane協(xié)作網(wǎng)推薦采用的新的 偏倚風(fēng)險(xiǎn)評(píng)估‖工具來評(píng)價(jià)文獻(xiàn)質(zhì)量,采用最新的RevMan 5.3.0軟件進(jìn)行Meta分析。結(jié)果本研究共納入16篇文獻(xiàn),進(jìn)一步排除數(shù)據(jù)后納入8篇文獻(xiàn)進(jìn)行分析。納入文獻(xiàn)2篇為病例對(duì)照試驗(yàn),屬于回顧性試驗(yàn),其余6篇為隨機(jī)對(duì)照試驗(yàn)(RCT),屬于前瞻性試驗(yàn),其中英文6篇,中文2篇,共包括455例患者。其中MMC熱灌注治療組共171例患者,MMC單獨(dú)應(yīng)用組共170例患者;治療劑量組38例患者,預(yù)防劑量組46例患者。Meta分析結(jié)果顯示:熱灌注MMC治療組和單獨(dú)MMC治療組的化療療效相比,整體風(fēng)險(xiǎn)比為0.17(95%CI,0.10,0.28);治療劑量組與預(yù)防劑量組的復(fù)發(fā)對(duì)比整體風(fēng)險(xiǎn)比為0.66(95%CI,0.22,2.02);熱灌注MMC治療組和單獨(dú)MMC治療組化療后疾病進(jìn)展率,整體風(fēng)險(xiǎn)比為0.62(95%CI 0.13,3.03),無統(tǒng)計(jì)學(xué)意義;膀胱痙攣在病人中發(fā)生率為11.8%,膀胱疼痛發(fā)生率為12.9%;膀胱痙攣更容易出現(xiàn)在預(yù)防性治療中(17.8%vs 10.7%;p=0.398),而疼痛的出現(xiàn)在預(yù)防性計(jì)劃和治療性計(jì)劃中基本相同,但是,更常見于治療性計(jì)劃中(17.0%vs 15.6%;p=0.366)。而疼痛的出現(xiàn)在預(yù)防性計(jì)劃和治療性計(jì)劃中的概率基本相同,相比之下更常見于治療性計(jì)劃中(17.0%vs15.6%;p=0.366)。該meta分析結(jié)果的風(fēng)險(xiǎn)偏倚程度較小,結(jié)果較為可信。結(jié)論我們的系統(tǒng)綜述表明,膀胱熱灌注化療和灌注化療治療非肌層浸潤(rùn)性膀胱癌(NMIBC)術(shù)后的療效相比,膀胱熱灌注后病人復(fù)發(fā)的幾率與單純灌注化療相比降低83.0%,經(jīng)過熱灌注化療后膀胱的整體保存率達(dá)到87.6%。膀胱保全率與藥物劑量無明顯相關(guān)性。然而,由于數(shù)量有限的隨機(jī)試驗(yàn)和不同的研究設(shè)計(jì),還不能對(duì)其復(fù)發(fā)和進(jìn)展得出明確的結(jié)論。膀胱熱灌注化療較單純灌注化療通常有更多的不良反應(yīng),但是這種差異沒有統(tǒng)計(jì)學(xué)意義。由于納入系統(tǒng)評(píng)價(jià)文獻(xiàn)的數(shù)量較少,存在一定的選擇及發(fā)表的偏倚,缺乏大樣本的臨床隨機(jī)對(duì)照試驗(yàn)的支持,因此上述結(jié)論仍需今后更多的大樣本、多中心、高質(zhì)量的臨床隨機(jī)對(duì)照研究的進(jìn)一步驗(yàn)證。
[Abstract]:Objective to compare the advantages and disadvantages of bladder hyperthermic infusion chemotherapy and infusion chemotherapy in the treatment of non-muscle-invasive Bladder carcinoma of bladder after operation, and to evaluate the clinical efficacy and safety of the two chemotherapy methods. Methods Cochrane library MEDLINE (via PubMed search platform) was searched by computer. According to CBMU and WanFangang, a literature study on the clinical trial of bladder hyperthermic chemotherapy and bladder infusion chemotherapy for bladder cancer was made. Search time is up to October 15th 2015. Manually search several Chinese magazines related to bladder neoplasms from January 1993 to October 2015: Journal of Modern urogenital tumors, International Journal of Urology, Chinese Journal of Urology, and Clinical. Journal of Urology et al. The quality of the literature was evaluated by two independent reviewers using a new risk assessment tool recommended by Cochrane. Meta analysis was carried out with the latest software RevMan 5.3.0.Results 16 articles were included in this study, 8 articles were further excluded from the data, and 2 articles were included as case-control trials, which were classified as retrospective trials. The other 6 were randomized controlled trials, including 6 in Chinese and 6 in Chinese, and 2 in Chinese, including 455 patients, including 171 patients in MMC hyperthermic perfusion group, 170 patients in MMC alone group, 38 patients in treatment dose group, 38 patients in treatment dose group, 3 patients in Chinese group, 3 patients in Chinese group, 3 patients in Chinese group, 3 patients in Chinese group, 3 patients in Chinese group and 38 patients in dosage group. The results of meta analysis of 46 patients in prophylaxis dose group showed that the therapeutic effect of hyperthermic infusion of MMC was compared with that of MMC alone. The overall risk ratio was 0.17 ~ 95 ~ 0.10 ~ 0.28%, the overall risk ratio was 0.66 ~ 95 ~ 0.222.02 ~ 0.22 ~ 2.02 ~ 0.66 ~ 95%, the disease progression rate and the overall risk ratio were 0.62n ~ 95 ~ (95) CI 0.133.03 ~ 0. 62% in the MMC treatment group and MMC alone group respectively, and there was no significant difference in the overall risk ratio between the treatment group and the prophylaxis dose group (P < 0.05). The incidence of bladder spasm in patients was 11.8% and the incidence of bladder pain was 12.9%. Bladder spasm was more likely to occur in preventive treatment than 10.7% 0.398%, and pain occurred in both prophylactic and therapeutic plans, but, The incidence of pain in prophylactic and therapeutic plans was almost the same, compared with 17.0vs15.6g in therapeutic plans. The risk bias of the results of the meta analysis was lower. Conclusion our systematic review shows that the efficacy of intravesical hyperthermic chemotherapy and infusion chemotherapy in the treatment of non-myometrial invasive bladder cancer is more effective than that of NMIBC+. The rate of recurrence was 83.0% lower than that of chemotherapy alone. The overall survival rate of bladder was 87.6% after hyperthermic chemotherapy. There was no significant correlation between bladder preservation rate and drug dosage. Due to a limited number of randomized trials and different research designs, it is not possible to draw a definite conclusion on the recurrence and progression of bladder hyperthermia chemotherapy. However, the difference was not statistically significant. Due to the small number of papers included in the systematic evaluation, the existence of certain selection and publication bias, and the lack of support from large clinical randomized controlled trials, Therefore, more large, multicenter, and high quality randomized controlled clinical trials are needed in the future.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.14

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