Comparative Study Of The Efficacy Of Gemcitabine And Hydroxy-camptothecin Intravesical Instillation On Prevention Of Postoperative Recurrence Of Bladder Tumor

Objective:To evaluate the safety and effect of gemcitabine(GEM)intravesical instillation chemotherapy on prevention of postoperative recurrence of bladder tumor by comparing the recurrence rate and other indicators of bladder cancer treated with gemcitabine and hydroxy-camptothecin(HCPT)intravesical instillation.This study will provide the basis for the selection of intravesical instillation drugs during clinical diagnosis and treatment.Method:The clinical data of 120 patients with non muscle-invasive bladder cancer(NMIBC)who underwent transurethral resection of bladder tumor and instillation therapy or patients with T2 a bladder cancer who underwent partial cystectomy and instillation therapy in our hospital from August 2017 to October 2018 were retrospectively analyzed.These patients were divided into two groups: GEM and HCPT according to the different infusion drugs.Each group is further divided into three levels of intermediate risk,high risk,and T2 a stage according to the different risks.Among them,eighty patients in the GEM group were treated with GEM 1200 mg intravesical instillation;forty patients in the HCPT group were treated with HCPT 30 mg intravesical infusion.The followup period was 1 year.The time of tumor recurrence(or progression)was determined by pathological examination of cystoscopy and tissue biopsy,and adverse reactions were graded according to severity.The tumor recurrence rate,progression rate and the incidence of adverse reactions after quantification were analyzed by chi-square test.Kaplan-Meier survival curve was used to analyze the recurrence-free survival period(RFSP)of the tumors in the two groups and tested by log-rank test.The significance level was taken as ?=0.05.Result:The total recurrence rate of 120 patients within 1 year after surgery was 19.17%.The recurrence rate of bladder cancer in the GEM group was 13.75% and that in the HCPT group was 30.00%.The recurrence rate in the GEM group was significantly lower than that in the HCPT group(P<0.05).Comparing the recurrence rates of NMIBC patients at each risk level between the two groups,we found that there was no significant difference in the intermediate-risk recurrence rates between the two groups(P>0.05).Among the high-risk patients,the recurrence rate in the GEM group was 18.42%,and that in the HCPT group was 52.94%;the recurrence rate of relapsed patients in the GEM group was 19.05%,and that in the HCPT group was 60.00%,the differences between the two groups was statistically significant(P<0.05).All 7 patients with T2 a stage in both groups did not relapse and metastasize within 1 year.There was also no significant difference in the progression rates(6.25% and 7.50%)between the GEM group and the HCPT group(P>0.05).The average RFSP of GEM group and HCPT group was 11.61±0.16 months and 10.98±0.38 months,respectively.The RFSP of GEM group was higher than that of HCPT group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions of patients in the GEM group and the HCPT group was 33.75% and 30.00%,respectively;and the incidence of irritation symptoms of bladder were 28.75% and 22.50%,respectively;and the incidence of toxic side effects was 5.00% and 7.50%,respectively.There was no significant difference in the incidence of adverse reactions between the two drugs within 1 year(P>0.05).Conclusion:GEM intravesical instillation chemotherapy is effective in prevention of postoperative recurrence of NMIBC.Its efficacy is better than HCPT,especially for relapsed patients or patients with high-risk NMIBC.In addition,both drugs have high safety.