本文選題：肌層浸潤性膀胱癌 + 新輔助放療��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析新輔助放療聯(lián)合根治性綠激光汽化術(shù)(radical photoselective vaporization of bladder tumors,RPVBT)及輔助化療的治療模式與傳統(tǒng)膀胱癌根治術(shù)(radical cystectomy,RC)對(duì)于肌層浸潤性膀胱癌(muscle invasive bladder cancer,MIBC)的臨床療效,比較兩組患者術(shù)后圍手術(shù)期并發(fā)癥、生存率以及生活質(zhì)量的差異,探索MIBC患者保留膀胱治療的新方法。方法:收集2008年3月至2012年3月期間天津市人民醫(yī)院收治的207例肌層浸潤性膀胱癌患者的臨床資料,篩選影像學(xué)檢查及膀胱鏡活檢證實(shí)為T2~T3a期并符合入排標(biāo)準(zhǔn)的MIBC患者143例,依據(jù)患者接受的治療方案分為RPVBT組和傳統(tǒng)根治組,其中RPVBT組納入87例,而傳統(tǒng)根治組納入56例。RPVBT組患者術(shù)前接受新輔助適形調(diào)強(qiáng)放療(IMRT,44~50Gy/25~30次/5~6周),并根據(jù)患者耐受程度,于放療結(jié)束后4~6周行RPVBT術(shù),術(shù)后給予患者4~6周期的吉西他濱聯(lián)合順鉑(GC方案)輔助化療。傳統(tǒng)根治組MIBC患者則常規(guī)行全膀胱切除加淋巴結(jié)清掃術(shù),術(shù)后病理p T3a伴淋巴結(jié)轉(zhuǎn)移者給予GC方案化療。收集兩組患者圍手術(shù)期并發(fā)癥、生存及復(fù)發(fā)情況的相關(guān)信息,并評(píng)估兩組患者不同時(shí)間點(diǎn)生活質(zhì)量量表(膀胱腫瘤特異性調(diào)查表Functional Assessment of Cancer Therapy-Bladder,FACT-BL,見附錄),比較兩組患者術(shù)后生存情況、腫瘤復(fù)發(fā)率、并發(fā)癥及生活質(zhì)量,探討兩種治療方式的療效差異。結(jié)果:RPVBT組患者接受新輔助放療后部分患者腫瘤體積明顯縮小甚至消失,其有效率(完全緩解+部分緩解)達(dá)到77.0%(67/87);新輔助放療對(duì)胃腸道干擾小,主要的并發(fā)癥為放射性膀胱炎。RPVBT組患者術(shù)后嚴(yán)重并發(fā)癥發(fā)生率(16.1%)顯著低于傳統(tǒng)手術(shù)組(44.6%)。RPVBT組術(shù)后1、2、3、4、5年生存率分別為96.6%、88.5%、70.1%、57.5%、44.8%;傳統(tǒng)傳統(tǒng)根治組術(shù)后1、2、3、4、5年生存率分別為92.9%、85.7%、69.6%、67.9%、66.1%,統(tǒng)計(jì)學(xué)分析結(jié)果顯示RPVBT組與傳統(tǒng)根治組患者術(shù)后生存率無顯著統(tǒng)計(jì)學(xué)差異(P=0.665)。通過生活質(zhì)量問卷調(diào)查表發(fā)現(xiàn):所有MIBC患者術(shù)后3、6、12、24、36、48、60個(gè)月患者FACT-BL評(píng)分表現(xiàn)出逐漸遞增趨勢,RPVBT組評(píng)分顯著高于傳統(tǒng)根治組患者(P=0.01)。結(jié)論:與傳統(tǒng)膀胱癌根治術(shù)相比,新輔助放療聯(lián)合RPVBT及術(shù)后輔助化療術(shù)后嚴(yán)重并發(fā)癥發(fā)生率低,而總體生存率無顯著差異,并且患者術(shù)后生活質(zhì)量明顯高于傳統(tǒng)根治手術(shù)。由此可見,新輔助放療聯(lián)合RPVBT及術(shù)后GC方案輔助化療是T2~T3a期肌層浸潤性膀胱癌患者保留膀胱治療的新的治療模式。
[Abstract]:Objective: to analyze the therapeutic effects of neoadjuvant radiotherapy combined with radical green laser vaporization (RPV) and adjuvant chemotherapy in the treatment of muscle invasive bladder carcinoma of bladder. To compare the difference of perioperative complications, survival rate and quality of life between the two groups, and to explore a new method of bladder retention therapy in patients with MIBC. Methods: the clinical data of 207 patients with myometrial invasive bladder cancer admitted to Tianjin people's Hospital from March 2008 to March 2012 were collected. 143 cases of MIBC confirmed by imaging examination and cystoscopic biopsy were confirmed as T2~T3a and in accordance with the admission criteria. The patients were divided into RPVBT group and traditional radical therapy group according to the treatment plan, including 87 cases in RPVBT group and 56 cases in traditional radical mastectomy group. 56 patients in traditional radical mastectomy group received neoadjuvant conformal intensity modulated radiotherapy before operation. RPVBT was performed 4 ~ 6 weeks after radiotherapy. Patients were treated with gemcitabine plus cisplatin GC regimen for 4 ~ 6 cycles. In the traditional radical group, the patients with MIBC were treated with total cystectomy and lymph node dissection. The patients with postoperative pathological pT3a and lymph node metastasis were treated with GC regimen chemotherapy. To collect information about perioperative complications, survival and recurrence in both groups, The quality of life (QOL) scale (Functional Assessment of Cancer Therapy-Bladderdern FACT-BLS) at different time points was evaluated. The survival status, tumor recurrence rate, complications and quality of life were compared between the two groups. To explore the difference of curative effect between two kinds of treatment methods. Results after neo-adjuvant radiotherapy, the tumor volume decreased or even disappeared in some of the patients in the RPVBT group, and the effective rate (complete remission) reached 77.067 / 87, and the neoadjuvant radiotherapy had little interference with gastrointestinal tract. The main complications were the incidence of severe postoperative complications in the radiation-cystitis .RPVBT group (16.1) significantly lower than that in the traditional operation group (44.6U 路RPVBT group). The 5-year survival rate was 96.688. 50.1% and 57.5%, respectively, and the 5-year survival rate was 92.95.79.69.69.69.69.67.90.The 5-year survival rate was 92.95.79.69.69.69.67.9and 66.1respectively, and the 5-year survival rate was 92.95.79.69.69.66.1. The results showed that there was no significant difference in the postoperative survival rate between the RPVBT group and the traditional radical group. Through the quality of life questionnaire, we found that all the patients with MIBC showed a gradual increasing trend of FACT-BL score at 60 months after operation. The FACT-BL score in all patients with MIBC was significantly higher than that in the traditional radical cure group. Conclusion: compared with conventional radical resection of bladder cancer, the incidence of severe complications after neoadjuvant radiotherapy combined with RPVBT and postoperative adjuvant chemotherapy is lower, but the overall survival rate is not significantly different, and the postoperative quality of life of the patients is significantly higher than that of traditional radical surgery. Therefore, neoadjuvant radiotherapy combined with RPVBT and postoperative GC regimen adjuvant chemotherapy is a new mode of bladder retention therapy in patients with T2~T3a stage myometrial invasive bladder cancer.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.14

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