The Effect Of Different Postoperative Instillation Therapy Time On The Recurrence Rate Of Bladder Tumor

Objective:Bladder tumor is one of the most frequently malignant tumors in urology,and it has the highest incidence in urogenital system of our country.The main way to treat non-muscle invasive bladder cancer is transurethral resection of bladder tumor,but the postoperative recurrence rate is high.Therefore,bacillus calmette-guerin or chemotherapy drug instillation therapy is often used to reduce the recurrence rate of bladder tumor.We usually use gemcitabine hydrochloride for instillation therapy,the instillation therapy time of the drug in bladder may affect the postoperative recurrence,but there is no systematic study to confirm this view.In this study,we summarized the influence of different instillation therapy time on the postoperative recurrence rate and side effects of bladder cancer in order to optimize the treatment measures.Methods:We retrospectively analyzed the clinical data of 120 cases after surgery with High-grade non-muscle invasive bladder cancer patients at the First Affiliated Hospital of Dalian Medical University from the January 2013 to January 2015.All patients adept gemcitabine 1000mg/50 ml for urinary bladder irrigation chemotherapy within 24 h after the operation.The instillation therapy was performed once a week from the second week after the operation,After 8 times,it was changed to 1 time per month,The total course of treatment is one year.All patients were followed up 4~24months,and the median follow-up time was 16 months.The instillation therapy time is defined as the time of the drug infusion into the bladder to the first urination time.It was suggested that the instillation therapy time was 2 hours,but there was a significantdifference in the instillation therapy time of patients.The instillation therapy time of all patients with urinary bladder irrigation chemotherapy was recorded,and we take the average value as the the instillation therapy time.120 cases were divided into 30 min group 40 cases,60 min group 40 cases and 120 min group 40 cases according to the instillation therapy time.We recorded the data of recurrence and side effects during the follow-up period to compare the recurrence and side effects among the three groups with statistical methods.Results:In terms of tumor recurrence,instillation therapy time 30 min group 40 cases,60 min group 40 cases and 120 min group 40 cases,tumor recurrence cases during the follow-up period were 17 cases,6 cases,5 cases respectively,and 30 min,60 min and 120 min recurrence rate during the follow-up period respectively was 42.5%,15.0%,12.5%;three groups showed statistical significance(P< 0.05);30 min and 60 min was statistically significant(P <0.0167)(In the case of multiple comparisons,Bonferroni correction is required,and the test level standard ? is adjusted to 0.05/3,which is 0.0167);30 min and 120 min was statistically significant(P<0.0167);However,60 min and 120 min showed no statistical significance(P>0.0167).We found that instillation therapy time was a protective factor according to the Logistic regression analysis.Among the 120 patients during the follow-up period,a total of 51 patients had the side effects after instillation therapy.In terms of the side effects,42 patients occurred bladder irritation during the follow-up period,5 patients occurred bladder irritation and hematuria,2 patients occurred hematuria,1 patient occurred bladder irritation,hematuria,nausea,vomiting and granulocytopenia,1 patient occurred nausea and vomiting.Instillation therapy time 30 min group 40 cases,60 min group 40 cases and 120 min group 40 cases,there were 6 cases,16 cases and 29 cases of side effects during the follow-up period,and the side effects rate was respectively:15.0%,40.0%,72.5%;three groups showed statistical significance(P<0.05);30 min and 60 min was statistically significant(P<0.0167)(In the case of multiple comparisons,Bonferroni correction isrequired,and the test level standard ? is adjusted to 0.05/3,which is 0.0167);30 min and 120 min was statistically significant(P<0.0167);60min and 120 min showed statistical significance(P<0.0167)Conclusion:The study shows that the instillation therapy time has a significant effect on the bladder tumor recurrence.By using gemcitabine hydrochloride for intravesical instillation,the clinical efficacy of 60 min and 120 min instillation therapy time are superior to 30 min instillation therapy time in the treatment of High-grade non-muscle invasive bladder cancer.The efficacy of 60 min and 120 min is similar.Nevertheless,the side effects of 120 min instillation therapy time are not satisfactory in comparison with60 min instillation therapy time.Therefore,60 min instillation therapy time could be the preferred choice for prevention of recurrence of High-grade non-muscle invasive bladder cancer when gemcitabine hydrochloride is used for intravesical instillation and the results of this study need to be further confirmed.