摘要：
目的 评价保留膀胱手术联合动脉化疗治疗T2期膀胱癌的疗效.方法 回顾性分析2000年1月至2014年12月收治的115例分期为T2N0M0膀胱癌患者的临床资料.其中35例临床分期为cT2N0M0的患者接受手术联合动脉化疗的保留膀胱治疗方案(A组),80例病理分期为pT2N0 M0的患者同期行根治性膀胱切除术(radical cystectomy,RC)治疗(B组).A组男33例(94.2％),女2例(5.8％);年龄51 ～ 96岁,中位年龄59岁;肿瘤直径≤3 cm者20例(57.1％),＞3 cm者15例(42.9％);肿瘤单发24例(68.6％),多发11例(31.4％);有膀胱癌病史者11例(31.4％).B组男71例(88.7％),女9例(11.3％);年龄49 ～ 70岁,中位年龄59岁;肿瘤直径≤3 cm者35例(43.8％),＞3 cm者45例(56.2％);肿瘤单发44例(55.0％),多发36例(45.0％);有膀胱癌病史者22例(27.5％).两组病理类型均证实为尿路上皮癌,两组基线数据比较差异均无统计学意义(均P＞0.05).比较两组患者的预后情况.结果 A组35例和B组80例患者的中位随访时间分别为68个月(13 ～157个月)和67个月(4～ 198个月).两组患者的疾病特异性生存率(diease-specificsurvival,DSS)分别为76.5％和60.6％,差异无统计学意义(P =0.888).A组有26例(74.3％)患者评估疗效达到完全缓解(complete response,CR).另外,A组中21例(60.0％)患者成功保留膀胱,此21例中位随访时间为69个月(13～134个月);8例患者在肿瘤复发后接受延迟的RC治疗,术后均未发现淋巴结转移,其中5例患者根治术后病理为T2期,2例为T3期,1例为T4期.该8例患者的DSS与B组患者比较,差异无统计学意义(P=0.809).Cox比例风险模型多因素分析结果显示,A组中只有肿瘤数量是预测无疾病生存(HR=0.238,P=0.007)的独立预测因子,CR是DSS的独立预后因素(HR=0.085,P=0.004).化疗过程中未观察到Ⅳ度血液毒性,Ⅰ、Ⅱ、Ⅲ度血液毒性分别为9例(25.7％)、6例(17.1％)和4例(11.4％).结论 保留膀胱手术联合动脉化疗治疗T2期膀胱癌远期疗效可靠、安全,是不宜接受RC患者的可选择的治疗方案.%Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.
