| BackgroundUrinary tract transitional cell carcinoma can occur within areas of the renal pelvis,ureter,bladder,and posterior urethra that are covered by transitional epithelial cells.The most common type of urinary tract transitional cell carcinoma is bladder cancer,followed by renal pelvis cancer.The possibility of developing transitional cell carcinoma in other parts of the urinary tract is very low.Bladder cancer(BC)is the most commonly malignant tumor of the urinary system.Its incidence is the 7th in male malignant tumors,and the 17 th in female malignant tumors,with its incidence on the rise.Bladder cancer can be divided into two main cancer groups: muscle invasive bladder cancer(MIBC)and non-muscle invasive bladder cancer(NMIBC)according to the depth and metastasis of the tumor.The vast majority of bladder cancer is NMIBC.Transurethral resection of bladder tumor(TUR-BT)is the main treatment for NMIBC.However,the high recurrence rate of NMIBC patients after operation is an urgent problem that needs to be solved in urology because of the intraoperative spread of tumor cells and the residual tumor cells in the wound.At present,a large number of studies suggest that postoperative combined bladder infusion can reduce the recurrence rate of non-invasive bladder cancer.NMIBC can be divided into three types: low-risk,middle-risk and high-risk according to the risk of recurrence and prognosis.The prognosis of low-risk NMIBC is good.It is generally believed that immediate perfusion after operation can achieve a lower recurrence rate without maintenance of perfusion.The prognosis of middle-risk and high-risk NMIBC is poor,with the recurrence rate and tumor progression much higher than low-risk NMIBC.It is necessary to maintain perfusion therapy which is the key in reducingthe tumor recurrence rate thereby improving the quality of life of the patients.The incidence of upper urinary tract transitional cell carcinoma is relatively low.Renal Pelvic Cancer accounts for about 10% of renal tumors whereas 5% of urinary tract is transitional cell carcinoma.The annual incidence of new cancer is(0.6-1.1)/100000,showing an increasing trend in recent years.Surgical resection is the main treatment in clinic,but due to the residual cancer cells during operation and other factors,about20%-50% of patients will have intravesical recurrence after operation.Intravesical recurrence occurs within 2 years after operation,focusing on about 5-15 months after operation.Presently,many studies believe that intravesical instillation chemotherapy after operation can reduce the recurrence rate of intravesical tumors for renal pelvic cancer after operation.However,there is no unified conclusion about the instillation regimen.Therefore,the same regimen is usually used as that used for NMIBC patients after operation.At present,there are many kinds of drugs commonly used in bladder perfusion therapy.Eprubicin(EPI),mitomycin,BCG,pirarubicin,hydroxycamptothecin,gemcitabine(GEM),Pseudomonas aeruginosa-mannose sensitive haemalutinin(PA-MSHA)are widely used.Their mechanisms of action,effects on recurrence rates and patient tolerance are different.In this study,we evaluated the safety and efficacy of EPI,GEM and PA-MSHA in adjuvant treatment of patients with middle-risk and high-risk NMIBC and renal pelvic cancer retrospectively.This was done using 79 patients with EPI after TUR-BT retrospectively compared with 85 patients with GEM after TUR-BT and 77 patients with PA-MSHA after TUR-BT.Then 24 patients with EPI after nephroureterectomy were retrospectively compared with 27 patients with GEM after nephroureterectomy and 25 patients with PA-MSHA after nephroureterectomy.PurposeTo investigate the efficacy and safety of intravesical instillation of epirubicin,gemcitabine and PA-MSHA in patients with middle-risk and high-risk non-muscle-invasive bladder transitional cell carcinoma and renal pelvic cancer afteroperation.MethodsTo compare the safety,efficacy and cellular immune function of NMIBC patients after TUR-BT treatment with two infusion drugs.A retrospective analysis was made on 241 patients with non-muscular invasive bladder cancer and 76 patients with renal pelvic cancer.According to the type of infusion drugs and tumors,the patients were divided into 6 groups: group A(EPI + bladder cancer),group B(GEM + bladder cancer),group C(PA-MSHA + bladder cancer),group D(EPI +renal pelvic cancer),group E(GEM + renal pelvic cancer),group F(PA-MSHA +renal pelvic cancer).According to the risk of recurrence and prognosis of tumors,the patients of groups A,B and C were further divided into high-risk and middle-risk subgroup.All patients were followed up to 2 years.Blood and urine test,liver and renal function,electrocardiogram,chest X-ray,urinary ultrasonography,computed tomography,cystoscopy was checked regularly in each follow-up.And adverse reactions of perfusion and recurrence of the tumors were observed.ResultThe incidence of adverse reactions was 33.90%(20/59)in middle-risk subgroup in group A,14.75%(9/61)in middle-risk subgroup in group B,10.71%(6/56)in middle-risk subgroup in group C.There were significant differences in the incidence of adverse reactions between the middle-risk patients in the three groups(P<0.05).There was significant difference in the incidence of adverse reactions between the middle-risk patients in groups A and B(P<0.0167).There was also significant difference in the incidence of adverse reactions between the middle-risk patients in group A and group C(P<0.0167).No significant difference in the incidence of adverse reactions between the middle-risk patients in group B and group C was observed(P>0.0167).The incidence of adverse reactions was 55.00%(11/20)in high-risk subgroup in group A,16.67%(4/24)in high-risk subgroup in group B,14.29%(3/21)in high-risk subgroup in group C.There were significantdifferences in the incidence of adverse reactions between the high-risk patients in the three groups(P<0.05).There was significant difference in the incidence of adverse reactions between the high-risk patients in group A and group B(P<0.0167),there was significant difference in the incidence of adverse reactions between the high-risk patients in group A and group C(P<0.0167),there was no significant difference in the incidence of adverse reactions between the high-risk patients in group B and group C(P>0.0167).The incidence of adverse reactions was 45.83%(11/24)in group D,14.81%(4/27)in group E,12.00%(3/25)in group F.There were significant differences in the incidence of adverse reactions between the patients in the three groups(P<0.05).There was significant difference in the incidence of adverse reactions between group D and group E(P<0.0167),there was significant difference in the incidence of adverse reactions between group D and group F(P<0.0167),there was no significant difference in the incidence of adverse reactions between group E and group F(P>0.0167).The recurrence rate was 28.81%(17/59)in the middle-risk subgroup in group A,27.87%(17/61)in the middle-risk subgroup in group B,8.93%(5/56)in the middle-risk subgroup in group C.In the three groups of relapsed patients,the recurrence-free survival time was 10.59 ± 4.68 months for the middle-risk subgroup in group A,11.29±4.79 months for the middle-risk subgroup in group B,and 17.20±4.44 months for the middle-risk subgroup in group C.There were significant differences in recurrence rate between middle-risk patients in the three groups in two years(P<0.05).There was no significant difference in recurrence rate between middle-risk patients in group A and group B in two years(P>0.0167).However,there was significant difference in recurrence rate between middle-risk patients in group A and group C in the two years(P<0.0167),there was also significant difference in recurrence rate between middle-risk patients in group B and group C in tow years(P<0.0167).In the three groups of relapsed patients,there were significant differences in recurrence-free survival time between middle-risk patients in the three groups(P<0.05).It was observed that there was no significant difference in recurrence-free survival time between middle-risk patients in group A and group B(P>0.0167),however there was significant difference in recurrence-freesurvival time between middle-risk patients in group A and group C(P<0.0167),and also significant difference in recurrence-free survival time between middle-risk patients in group B and group C(P<0.0167).The recurrence rate was 50.00%(10/20)in high-risk subgroup in group A,45.83%(11/24)in high-risk subgroup in group B,47.62%(10/21)in high-risk subgroup in group C.In the three groups of relapsed patients,the recurrence-free survival time was 9.10±5.22 months for the high-risk subgroup in group A,10.55±5.30 months for the high-risk subgroup in group B,and 9.50±5.23 months for the high-risk subgroup in group C.There were no significant differences in relapse rates of tumor recurrence between high-risk patients in the three groups in two years(P>0.05).There were no significant differences in recurrence-free survival time between high-risk patients in the three groups(P>0.05).The recurrence rate was 33.33%(8/24)in group D,29.63%(8/27)in group E,25.00%(6/24)in group F.In the three groups of relapsed patients,the recurrence-free survival time was 9.50±3.85 months in group D,9.63±3.96 months group E,and15.33±3.08 months in group F.There were no significant differences in relapse rates of tumor recurrence between three groups in two years(P>0.05).However,there were significant differences in recurrence-free survival time between patients in the three groups(P<0.05).There was no significant difference in recurrence-free survival time between group D and group E(P>0.05).There was significant difference in recurrence-free survival time between group D and group F(P<0.05),and there was significant difference in recurrence-free survival time between group E and group F(P<0.05).Conclusion1.In patients with middle-risk non-muscular invasive bladder cancer,the incidence of adverse reactions of intravesical instillation of PA-MSHA was lower than that of epirubicin,and the recurrence of the rate of intravesical instillation of PA-MSHA was lower than that of epirubicin and gemcitabine in two years.Also the recurrence-free survival time of intravesical instillation of PA-MSHA was longerthan that of epirubicin and gemcitabine in relapsed patients.Thus as observed,intravesical instillation of PA-MSHA had the best efficacy among the three schemes.2.In patients with high-risk non-muscular invasive bladder cancer,the incidence of adverse reactions of intravesical instillation of epirubicin were more than that of gemcitabine and PA-MSHA,the three schemes of intravesical instillation showed no significant difference in the recurrence rate and the recurrence-free survival time in relapsed patients.3.In patients with renal pelvic cancer,the incidence of adverse reactions of intravesical instillation of PA-MSHA was lower than that of epirubicin.The recurrence rate of intravesical instillation of PA-MSHA was similar to that of epirubicin and gemcitabine in two years,whereas recurrence-free survival time of patients with recurrence was much longer than that of epirubicin and gemcitabine. |
PDF Full Text Request