發(fā)布時間：2018-06-15 17:14

  本文選題：浸潤 + 膀胱癌��； 參考：《華中科技大學(xué)》2014年博士論文

【摘要】：目的： 對于TURBT術(shù)后維持膀胱灌注化療時間對預(yù)防非浸潤性膀胱癌復(fù)發(fā)和進(jìn)展的影響進(jìn)行比較 方法學(xué)： 為了比較這兩種不同時長(半年以下與一年以上)灌注方法的優(yōu)劣,幾個較大的數(shù)據(jù)庫(Medline, EMBASE, Web of Science及Cochrane Library data bases)均依次進(jìn)行了檢索。檢索過程中,檢索詞均以主題詞及自由詞的參與檢索。風(fēng)險比(HR)及其95%可信區(qū)間作為統(tǒng)計量被用來評價膀胱腫瘤的復(fù)發(fā)率。我們使用了考克蘭合作組織(Cochrane Collaboration)推薦的軟件Revman5.2進(jìn)行數(shù)據(jù)分析。對于風(fēng)險比的計算,我們采用的是“實驗組觀察值-實驗組期望值(0-E)”除以“方差(V)”的計算方法。為了減小異質(zhì)性,我們分別采用了敏感性分析及亞組分析。最后,同樣由考克蘭合作組織推薦的GRADEpro3.6軟件被用來做文章的質(zhì)量評價。 結(jié)果： 該系統(tǒng)評價共納入13個合格的臨床隨機(jī)對照試驗(RCTs),包含4216名符合標(biāo)準(zhǔn)的患者及16個符合標(biāo)準(zhǔn)的分組對比�？偟姆治鲲@示,長療程術(shù)后膀胱灌注化療與短療程術(shù)后膀胱灌注化療相比并未表現(xiàn)出優(yōu)勢[HR0.99,95%CI(0.89,1.11),P=0.89]。進(jìn)一步的亞組分析顯示：經(jīng)尿道膀胱腫瘤切除術(shù)(TURT-BT)后24小時內(nèi)完成即刻膀胱灌注化療的病人,其長療程灌注化療效果較短療程相比有一定優(yōu)勢[HR0.83,95%CI(0.69,1.00),P=0.05].不過,術(shù)后延遲膀胱灌注化療的病人則無此差異；在藥物方面,采用表柔比星(EPI)灌注的病人其長程灌注效果與短程灌注效果相比無明顯優(yōu)勢[HR1.01,95%CI (0.90,1.15),P=0.82]；初發(fā)的膀胱腫瘤病人較復(fù)發(fā)腫瘤患者能夠從長程灌注化療中獲得更大的益處[HR0.77,95%CI (0.63,0.94),P=0.01].但是,長程灌注化療在預(yù)防腫瘤進(jìn)展方面似乎作用不大[HR0.96,95%CI(0.66,1.39),P=0.82]. 結(jié)論： 首先,腫瘤復(fù)發(fā)方面：對于接受即刻術(shù)后灌注化療的患者和初發(fā)的腫瘤患者,一年以上的維持灌注化療較半年以下相比能夠進(jìn)一步降低腫瘤的復(fù)發(fā)率；其他患者不能從半年以上的維持灌注治療中進(jìn)一步獲益；使用表柔比星作為灌注藥物時,同樣不應(yīng)超過半年。其次,腫瘤進(jìn)展方面：一年以上的膀胱灌注較半年以下相比不能進(jìn)一步預(yù)防腫瘤進(jìn)展。再次,一年以上膀胱灌注并不會明顯增加不良反應(yīng)的發(fā)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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.14

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