Efficacy Evaluation Of Transcatheter Arterial Chemoembolization Combined With Transurethral Resection Of Bladder Tumor In The Treatment Of Bladder Cancer

Objective:In recent years,the incidence of bladder cancer is increasing,and the treatment methods are also increasing.Transurethral cystectomy(BURBT)or partial cystectomy is the standard treatment for early bladder cancer,but the postoperative recurrence rate is high.Transcatheter bladder arterial chemoembolization(BACE)provides a rapid and effective hemostasis method for the treatment of bladder cancer with refractory bleeding,and it has the characteristics of less trauma and less side effects.Meanwhile,it provides an effective method of bladder conservation for patients who are unwilling or unable to receive cystectomy.We studied the efficacy of bladder arterial chemoembolization combined with electroresection of bladder tumor in the treatment of early bladder cancer.Methods:From January 2015 to December 2018,48 cases of bladder cancer with hematuria in The Sixth Medical Center of The General Hospital of the People’s Liberation Army of China and Central South Hospital of Wuhan University were retrospectively studied,with stage T1 and T2a(34 cases of T1 and 14 cases of T2a),pathological type of urothelial carcinoma(22 cases of G1 stage and 26 cases of G2-G3 stage).There were 38 males and 10 females,aged from 45 to 85(mean:70.58±10.72)years,18 cases with single lesions and 30 cases with multiple lesions,none of which had lymph node or distant metastasis.All patients had gross hematuria,and all patients were first treated.Before surgery,all patients underwent detailed pelvic MRI or CT examinations.The main symptoms were: different degrees of gross hematuria in 48 cases(100%),dysuria with hematocele in 5 cases(10.42%),frequency of urination in 5cases(10.42%),pain in urination in 3 cases(6.25%),severe hemorrhagic anemia(hemoglobin ≤60/L)in 2 cases(4.17%).Patients were divided into two groups according to whether BACE was performed before resection of bladder tumor: the combined BACE group(n=24)received BACE,and BURBT was performed 3-5 days after resection.The mean age of patients was 71.78±10.61.There were 18 males and 6 females.The tumor stages were T1 in 16 cases and T2 a in 8 cases.The control group(n=24)received BURBT directly,and the mean age of patients was 70.13±10.72.There were 20 males and 4 females.Tumor stage:T1 in 18 cases,T2 in 6 cases.Both groups received bladder perfusion chemotherapy after surgery.To observe the hemostatic effect of BACE and the adverse reactions during and after operation.The control group underwent TURBT directly.The amount of intraoperative TURBT blood loss,TURBT operation time and postoperative TURBT hospital stay were compared between the two groups.All patients were followed up for 2years,and the recurrence rate at 12 months and 24 months was statistically compared between the two groups.The progression-free survival rate at 12 and 24 months and the survival rate at 24 months were compared between the two groups.The mean progression-free survival time within 2 years was compared.Cox regression model was used to analyze the prognostic factors.Results:After BACE combined with BACE,all patients’ gross hematuria disappeared,and the success rate of hemostasis reached 100%.No serious adverse reactions or complications related to chemotherapy and embolization occurred in all patients after BACE.TURBT blood loss was(40.42±13.38)ml and(56.25±15.50)ml in the combined BACE group and the control group,and TURBT operation time was(46.63±7.38)min and(59.79±8.84)min,respectively.TURBT postoperative hospital stay was(4.58±1.61)days and(6.08±2.22)days,respectively,with statistically significant differences(P<0.05).Patients in both groups were followed up for 2 years.The postoperative recurrence rates of the combined BACE group and the control group were 8.33% and 33.33%,respectively,12 months after surgery,and 20.83% and 50%,respectively,24 months after surgery,with statistically significant differences(P<0.05).Comparison of progression-free survival between the combined BACE group and the control group: the progression-free survival rates at 12 months after surgery were 91.67% and 66.67%,and the progression-free survival rates at 24 months were 79.17% and 50.00%,respectively,with statistically significant differences(P<0.05);The 24-month survival rates of BACE group and control group were 95.83% and 91.67%,respectively,and the difference was not statistically significant(P>0.05).The mean 2-year progression-free survival time in BACE group and control group was(15.43±5.26)months and(10.19±4.85)months,respectively,and the difference was statistically significant(P<0.05).Cox regression analysis of the prognosis of the two groups showed that clinical stage(P= 0.004),pathological grade(P=0.024),whether combined with BACE(P<0.001)was an independent factor affecting recurrence of bladder cancer after treatment.Conclusion: BACE can effectively control bladder bleeding in patients with bladder cancer and has high safety.For patients with T1-T2 a stage bladder cancer,BACE before BURBT can effectively reduce intraoperative bleeding of BURBT,shorten the duration of BURBT surgery and hospital stay.Preoperative BACE can reduce postoperative recurrence rate,improve progression-free survival rate and prolong progression-free survival time of T1-T2 a bladder cancer BURBT.