浅表性膀胱癌经尿道术后早期灌注化疗临床预后的系统评估

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李涛, 杨立, 明星, 王志平. 浅表性膀胱癌经尿道术后早期灌注化疗临床预后的系统评估. 循证医学, 2013,13(3): 147-151
LI Tao, YANG Li, MING Xing, WANG Zhi-ping. Early Intravesical Chemotherapy after Transurethral Resection of Non-Muscle-Invasive Bladder Cancer： A Systematic Review. Journal of Evidence-Based Medicine,2013, 13(3): 147-151 复制到剪切板

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浅表性膀胱癌经尿道术后早期灌注化疗临床预后的系统评估

李涛, 杨立, 明星, 王志平

兰州大学泌尿外科研究所、兰州大学第二医院泌尿外科、甘肃省泌尿系统疾病临床医学中心、甘肃省泌尿系统疾病研究重点实验室, 兰州 730030

摘要

目的系统评价浅表性膀胱癌经尿道术后早期灌注化疗对肿瘤复发及进展的影响。方法检索PubMed、EMBASE、CNKI、VIP及万方数据库,检索时间从建库至2012年4月,收集浅表性膀胱癌经尿道术后早期灌注化疗的随机对照试验。由2名研究者按照纳入排除标准筛选文献,评价质量并应用RevMan 5.0进行Meta分析。结果经过评价共纳入4个随机对照研究,合计909例浅表性膀胱癌患者。Meta分析显示：术后灌注可降低肿瘤复发率（比值比0.46, 95%可信区间0.22~0.99,P=0.05）;而在改善肿瘤进展及降低死亡方面无此效应（比值比0.59, 95%可信区间0.20~1.72,P=0.34）。结论浅表性膀胱癌经尿道术后早期行化疗药物灌注,对降低肿瘤复发率有一定的作用,但不能改善肿瘤的进展及降低死亡率,化疗药物的副作用对患者的生活质量会产生不良影响。

关键词: 浅表性膀胱癌; 化疗; 临床预后; 随机对照试验; Meta分析

中图分类号:R737.1 文献标识码:A

Early Intravesical Chemotherapy after Transurethral Resection of Non-Muscle-Invasive Bladder Cancer： A Systematic Review

LI Tao, YANG Li, MING Xing, WANG Zhi-ping

Institute of Urology, Lanzhou University Second Hospital, Gansu Nephro-Urological Clinical Center, Key Laboratory of Diseases of Urological System Gansu Province, Lanzhou 730030, China

Abstract

Objective To evaluate the recurrence and progression of tumors treated with early intravesical chemotherapy after transurethral resection of non-muscle-invasive bladder cancer （TUR-bt）.Methods Randomized controlled trials （RCTs） about early intravesical chemotherapy after TUR-bt were retrieved on PubMed, EMBASE, CNKI, VIP and Wanfang databases from their establishment to April 2012. According to the inclusion and exclusion criteria, two reviewers independently screened the trials, extracted the data, assessed the quality, and conducted the meta-analysis with Revman 5.0 software finally.Results A total of four RCTs involving 909 superficial bladder cancer patients were eligible. The results of meta-analysis showed that there was statistical difference in tumor recurrence（OR=0.46, 95%CI 0.22~0.99P=0.05）. However, the effect of progression and reducing the death rate showed no significant difference with or without early instravesical chemotherapy （OR=0.59, 95%CI 0.20~1.72,P=0.34）.Conclusion Early instravesical chemotherapy after TUR-bt is effective in reducing the tumor recurrence. By contrast, it could not lower the progression and death rate, and the side effects of chemotherapy agents could effect the quality of life of patients.

Key words: non-muscle-invasive bladder cancer; chemotherapy; clinical outcome; randomized controlled trial; meta-analysis

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膀胱癌是泌尿系统常见的恶性肿瘤。其中,70%为浅表性肿瘤^{[ 1]}。治疗非浸润性膀胱癌的首选方法是经尿道电切除术（transurethral resection,TUR）,然而术后高复发率及进展为原位癌是临床急需解决的难题^{[ 2, 3]}。术后膀胱内行化疗药物灌注已得到广泛应用。许多研究表明,术后行药物灌注能够降低术后复发率并延长进展时间^{[ 4, 5, 6]}; 亦有报道显示,术后早期灌注化疗药物并不能改善患者的临床预后^{[ 7, 15]}。Kikuchi和Frydenberg等^{[ 11, 14]}报道,肿瘤分期及分级的初次诊断是影响肿瘤复发的危险因素。由于临床研究少,浅表性膀胱癌经尿道术后早期灌注化疗对肿瘤的复发及进展的影响尚缺乏循证医学证据的支持。

为给浅表性膀胱癌术后早期化疗药物的灌注提供更高、更可靠的临床依据,我们收集了术后24小时内行化疗药物灌注治疗浅表性膀胱癌的随机对照试验（randomized controlled trial,RCT）,并进行了系统评价,以期为临床医师治疗浅表性膀胱癌术后应用化疗药物灌注及对患者生活质量的改善提供循证医学的支持。

1 资料与方法

1.1 研究类型

RCT,语种限定为中英文。

1.2 研究对象

纳入标准：浅表性膀胱癌患者术后采用化疗药物灌注治疗。诊断标准采用膀胱癌2002 TNM分期法,不受年龄、种族、性别、病程、体重等限制。

排除标准：术后24小时以外的灌注化疗;未经手术直接采用化学药物治疗者;非膀胱灌注方式给药;除化疗药物外有其他干预措施;研究对象患有严重心脏或肾脏功能不全者;对化疗药物过敏或者严重全身反应不能耐受者;患有其他影响试验完成者。无法获取全文及详细摘要的文献,重复发表的文献。

1.3 干预措施

试验组给予化疗药物治疗,对照组不含化疗药物治疗,用药剂量及疗程不限。

1.4 疗效判断指标

主要指标为术后灌注化疗后肿瘤的复发率和肿瘤进展情况,次要指标为不良反应的发生率。

1.5 文献检索

1.5.1检索数据库

计算机检索PubMed、EMBASE,中文检索CNKI、万方数据库、维普数据库。由两位研究者分别独立检索文献,检索年限均从建库至2012年4月。

1.5.2检索策略

英文检索词： superficial bladder cancer、 non-muscle-invasive bladder cancer、 mitomycin C、thiotepa、 gemcitabine、 chemotherapy、 epirubicin、randomized controlled trial。

中文检索词：浅表性膀胱癌、非肌层侵润性膀胱癌、丝裂霉素C、塞替派、吉西他滨、化疗、表柔比星、随机对照试验。

PubMed数据库检索策略为：（“mitomycin C” or“thiotepa” or“gemcitabine” or “epirubicin”）and （“superficial bladder cancer” or “non-muscle-invasive bladder cancer”）。

1.6 资料提取

由两名研究者按照纳入、排除标准独立筛选文献,并按照预先设计好的资料提取表分别提取资料,排除明显不符合纳入标准的试验后,对可能纳入的资料阅读全文。最后交叉核对资料,如遇分歧,通过协商讨论解决。

1.7 纳入研究质量评价

纳入的研究从以下几方面进行质量评估,以考察各研究是否存在偏倚及影响程度：①试验设计是否科学;②研究对象的纳入标准及其基本构成特征是否明确;③处理因素及其方法是否正确;④统计方法是否得当;⑤是否就本研究存在的偏倚进行讨论。以上五项,每满足一项为1分,总分≥3分为质量可靠。

1.8 资料分析

应用RevMan 5.0 软件进行Meta 分析。各临床试验的异质性检验采用χ²检验,如有统计学异质性（ P<0.05; I²>50%）,采用随机效应模型进行数据合并,计算比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）,对可能导致异质性的因素进行分析,必要时,进行亚组分析;如无统计学异质性（ P>0.05; I²<50%）,采用固定效应模型进行数据合并。

2 结果

2.1 文献检索结果

通过检索共获得1 618篇文献,其中中文63篇,英文1 555篇。通过阅读文题、摘要及全文,排除综述、未设置空白对照组及对照组合并其他治疗,以及不是术后24小时内进行灌注化疗的研究,最终纳入4篇随机对照试验。文献筛选流程见图 1。

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	图1 文献筛选流程及结果

2.2 纳入研究的基本特征

纳入研究的基本特征见表1。

表1 纳入研究的基本特征

2.3 纳入研究的质量评价结果

纳入研究的质量评价结果见表2。

表2 纳入研究的质量评价

2.4 统计分析结果

2.4.1术后复发率的比较分析

有4项研究进行了膀胱癌术后早期灌注化疗对肿瘤复发率的评估^{[ 7, 8, 9, 10]},共纳入909例病人,其中化疗药物灌注组486例,空白对照组423例。异质性检验结果显示存在较大的异质性（ P=0.000 4, I²=84%）。故采用随机效应模型进行合并,结果显示： OR_合并 = 0.46, 95%CI 0.22~0.99, P=0.05。表明浅表性膀胱癌经尿道术后行药物灌注对降低肿瘤的复发率有一定的作用,见图2。

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	图2 术后早期化疗与不化疗组复发率情况比较的Meta分析

2.4.2术后行灌注化疗后肿瘤进展分析

有3项研究进行了浅表性膀胱癌经尿道术后早期行化疗药物灌注与不灌注对肿瘤进展情况影响的研究比较^{[ 7, 8, 9]},共690例病人,其中化疗组384例,对照组306例。各试验间异质性检验显示： P=0.82, I²=0%,表明无异质性,故采用固定效应模型进行Meta分析。结果显示两组差异无统计学意义（OR=0.59, 95%CI 0.20~1.72, P=0.34）,表明浅表性膀胱癌经尿道术后早期行化疗药物灌注,对降低肿瘤的进展及患者的死亡率无明显作用,见图3。

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	图3 术后早期化疗与不化疗组肿瘤进展情况比较的Meta分析

2.4.3安全性评价

有3项研究报道了化疗药物灌注治疗组出现膀胱刺激征、骨髓轻度抑制、血清转氨酶升高等症状^{[ 7, 8, 9]}。对照组病人仅1例出现发热。各研究间无异质性（ P=0.69, I²=0%）,采用固定效应模型进行Meta分析。结果显示,两组差异有统计学意义（OR=9.13, 95%CI 2.14~38.98, P=0.003）。表明浅表性膀胱癌经尿道术后早期行膀胱内化疗药物灌注,药物所致副作用对患者产生较大不良反应,见图4。

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	图4 药物副作用比较的Meta分析

3 讨论

浅表性膀胱癌是膀胱肿瘤中发病率较高的疾病^{[ 1, 12]},治疗的目的是阻止或延长疾病的进展。TUR术后行膀胱内化疗药物灌注为临床上常用的治疗方案。较为常用的药物有丝裂霉素、表阿霉素、吉西他滨等,其中,灌注药物的选择及用药方案对患者的临床预后有着重要的影响^{[ 6, 12, 13]}。对浅表性膀胱肿瘤患者使用化学药物预防治疗,能够增强对膀胱癌患者的长期监测^{[ 16]}。因此,通过对浅表性膀胱癌经尿道术后早期灌注化疗与否的临床结局进行比较,可以评价灌注化疗药物对改善患者预后的效果。

理想的试验应是治疗组与对照组患者选择标准一致,化疗药物灌注方案一致。由于本文纳入研究使用的化疗药物不统一、化疗方案不一致,合并的4个研究存在高度的异质性 P=0.000 4, I²=84%^{[ 7, 8, 9, 10]},故采用随机效应模型进行灌注后复发率评估,结果显示浅表性膀胱癌经尿道手术早期灌注化疗对膀胱癌的复发有一定的降低作用。在进展及死亡率方面,有3项研究异质性结果 P=0.82, I²=0%,采用固定效应模型检测结果表明,浅表性膀胱癌经尿道术后早期行灌注化疗不能阻止肿瘤的进展及减少死亡率^{[ 7, 8, 9]}。同时,化疗药物对患者产生的副作用较明显。

本系统评价存在的局限性：目前对浅表性膀胱癌经尿道术后早期行灌注化疗与否的临床对照研究较少,因此本文仅纳入4篇。另外,本文只纳入了英文发表的文献,分析结果可能存在发表偏倚或者其他偏倚。

此系统评价与国内外大多文献报道的结论不相一致,因此需要更多的高质量的、多中心的临床随机对照试验,为临床决策提供更可靠的证据。

The authors have declared that no competing interests exist.

参考文献

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2010

1.898

0.0

... 其中,70%为浅表性肿瘤^[1] ...

... 3 讨论浅表性膀胱癌是膀胱肿瘤中发病率较高的疾病^[1,12],治疗的目的是阻止或延长疾病的进展 ...

2004

1.325

0.0

Masood

, Sriprasad

, Palmer

, et al. T1G3 bladder cancer indications for early cystectomy[J]. Int Urol Nephrol, 2004, 36(1): 41-44.

1.Department of Urology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK

Objectives: To review our experience with early radical cystectomy in patients with T1G3 Transitional Cell Carcinoma of bladder (TCC). Patients and methods: Thirty patients, who underwent early radical cystectomy over a 10-year period for clinical stage T1G3 TCC bladder, were studied. Of these 21 (70%) had radical cystectomy without treatment with intravesical chemo/immunotherapy. The number of tumours, presence or absence of Carcinoma In-Situ (CIS) and the pathological stage of the cystectomy specimen were recorded in each patient. Disease specific survival was determined in the subgroups using Kaplan-Meier estimates. Results: Seventeen patients underwent radical surgery for a single tumour without concomitant CIS (Group A). The other 13 had multiple tumours with or without concomitant CIS or a single tumour with CIS (Group B). The disease was upstaged after cystectomy in 1 (6%) patient in Group A compared to 7 (55%) in Group B, (p = 0.009). Nine (53%) had pT0 disease in Group A compared to 0% in Group B, (p = 0.0017). The 5-year cancer specific survival rates were 92% in Group A and 82% in Group B. Conclusions: In patients with multiple T1G3 tumours with or without associated CIS, or in those with single T1G3 tumour with associated CIS the incidence of the disease being already muscle invasive at the time of clinical diagnosis is 55%. Early radical cystectomy should be advocated in this group. Conversely, for a single T1G3 tumour without associated CIS, conservative bladder preserving strategy with immuno-chemotherapy and close surveillance is justified.

2009

5.774

0.0

2001

0.0

2002

0.742

0.0

2000

5.332

0.0

... 较为常用的药物有丝裂霉素、表阿霉素、吉西他滨等,其中,灌注药物的选择及用药方案对患者的临床预后有着重要的影响^[6,12,13] ...

2009

10.476

0.0

Böhle

, Leyh

, Frei

, et al. Single postoperative instillation of Gemcitabine in patients with non-muscle-invasive transitional cell carcinoma of the bladder: A rand omised, double-blind, placebo-controlled phaseⅢ multicentre study[J]. Eur Urol, 2009, 56(3): 495-503.

Background

Recurrence prophylaxis with intravesical gemcitabine (GEM) was effective and safe in patients with non-muscle-invasive bladder cancer (NMIBC); efficacy as single-shot instillation remains to be proved.

Objective

To compare the efficacy of a single GEM instillation versus placebo (PBO) immediately after transurethral resection (TUR) of tumour in patients with histologically confirmed NMIBC (pTa/pT1,G1–3).

Design, setting, and participants

This was a double-blind, randomised, PBO-controlled study in patients with clinical evidence of primary or recurrent NMIBC (Ta/T1,G1–3). Of 355 patients randomised at 24 urologic centres, 328 underwent TUR and received instillation (92.4%; GEM/PBO: 166/162). In case of nonmalignancy, carcinoma in situ (CIS), ≥pT2 disease, or intraoperative complications, patients were discontinued.

Intervention

We used a single, postoperative 30–40-min instillation of GEM (2000 mg/100 ml of saline) or PBO (100 ml of saline) followed by continuous bladder irrigation for ≥20 h. A second TUR (no instillation) and adjuvant bacillus Calmette-Guérin (BCG) instillations were allowed.

Measurements

Primary outcome was recurrence-free survival (RFS). Secondary outcomes included type of recurrence and adverse events. To detect a difference in RFS, 191 recurrences were required (80% power, log-rank-test, α = 0.050).

Results and limitations

Two hundred forty-eight patients (69.9%, GEM, PBO: 124, 124) had histologically confirmed pTa/pT1 G1–3 Gx tumour and were eligible for efficacy (GEM: 76.6% male; median age: 65 yr; PBO: 83.1% male; median age: 67 yr). Treatment groups were balanced (pTa: 75.0%, 71.0%; G1–G2: 85.5%, 87.9%; recurrent tumour: 24.2%, 21.0%; BCG: 10.5%, 16.9%). After a median follow-up of 24 mo, there were only 94 recurrences and 11 deaths. The study was terminated early based on predefined decision criteria. RFS was high in both groups (12-mo RFS [95% confidence interval (CI)]: GEM: 77.7% [68.8–84.3]; PBO: 75.3% [66.3–82.3]). There was no significant group difference (hazard ratio [HR]: 0.946 [0.64–1.39], log-rank test, p = 0.777).

Conclusions

In this study of NMIBC, the immediate single instillation of GEM 2000 mg/100 ml of saline after TUR was not superior to PBO in terms of RFS. Rigid continuous irrigation and improved TUR/cystoscopy techniques may have contributed to the high RFS in both groups.

<ul><li id="aff1">aDepartment of Urology, Helios Agnes Karll Hospital, Bad Schwartau, Germany (on behalf of the German AUO Trial Group)</li><li id="aff2">bDepartment of Urology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany</li><li id="aff3">cDepartment of Urology, Johanniter Hospital, Stendal, Germany</li><li id="aff4">dDepartment of Urology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany</li><li id="aff5">eDepartment of Urology, Klinikum Wedel, Wedel, Germany</li><li id="aff6">fDepartment of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany</li><li id="aff7">gDepartment of Urology, St. Hedwig Hospital, Berlin, Germany</li><li id="aff8">hDepartment of Urology, Vivantes Klinikum am Urban, Berlin, Germany</li><li id="aff9">iSSK Tepecik Research and Education Hospital, Yenisehir Izmir, Turkey</li><li id="aff10">jMedical Department, Lilly Deutschland GmbH, Bad Homburg, Germany</li></ul>

... 亦有报道显示,术后早期灌注化疗药物并不能改善患者的临床预后^[7,15] ...

2010

2.888

0.0

Saika

, Tsushima

, Nasu

, et al. Two instillations of Epirubicin as prophylaxis for recurrence after transurethral resection of Ta and T1 transitional cell bladder cancer: A prospective, rand omized controlled study[J]. World J Urol, 2010, 28(4): 413-418.

Background

Although transurethral resection (TUR) is the standard treatment for non-muscle-invasive bladder tumors, 40–80% of tumors recur in spite of complete resection.

1.Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan 2.Department of Urology, National Okayama Medical Center, Okayama, Japan 3.Department of Urology, National Iwakuni Medical Center, Iwakuni, Japan 4.Department of Urology, Hiroshima City Hospital, Hiroshima, Japan 5.Department of Urology, Kagawa Prefectural Central Hospital, Takamatsu, Japan

2011

2.888

0.0

De Nunzio

, Carbone

, Albisinni

, et al. Long-term experience with early single Mitomycin C instillations in patients with low-risk non-muscle-invasive bladder cancer: Prospective, single-centre rand omised trial[J]. World J Urol, 2011, 29(4): 517-521.

1.Department of Urology, University “La Sapienza”, Rome, Italy 2.Ospedale Sant’Andrea, University “La Sapienza” Roma, Via di Grottarossa 1035, 00189, Rome, Italy

To study the benefits of a single, early, intravesical instillation of mitomycin C(MMC) after transurethral bladder resection (TURB) in patients with low-risk non-muscle-invasive bladder cancer (NMIBC).

2009

10.476

0.0

Gudjónsson

, Adell

, Merdasa

, et al. Should all patients with non-muscle-invasivebladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective rand omised multicentre study[J]. Eur Urol, 2009, 55(4): 773-780.

Background

To decrease recurrences in non–muscle-invasive bladder cancer (NMIBC), the European Association of Urology (EAU) guidelines recommend immediate, intravesical chemotherapy after transurethral resection (TUR) for all patients with Ta/T1 tumours.

Objective

To study the benefits of a single, early, intravesical instillation of epirubicin after TUR in patients with low- to intermediate-risk NMIBC.

Design, setting, and participants

In this prospective randomised multicentre trial, 305 patients with primary as well as recurrent low- to intermediate-risk (Ta/T1, G1/G2) tumours were enrolled between 1997 and 2004. Patients were randomly allocated to receive 80 mg of epirubicin in 50 ml of saline intravesically within 24 h of TUR or no further treatment after TUR.

Measurements

The primary end point was time to first recurrence.

Results and limitations

A total of 219 patients remained for analysis after exclusions. The median follow-up time was 3.9 yr. During the study period, 62% (63 of 102) of the patients in the epirubicin group and 77% (90 of 117) in the control group experienced recurrence (p = 0.016). In a multivariate model, the hazard ratio (HR) for recurrence was 0.56 (p = 0.002) for early instillation of epirubicin versus no treatment. In a subgroup analysis, the treatment had a profound recurrence-reducing effect on patients with primary, solitary tumours, whereas it provided no benefits in patients with recurrent or multiple tumours. Furthermore, patients with a modified European Organisation for Research and Treatment of Cancer (EORTC) risk score of 0–2 with and without single instillation had recurrence rates of 41% and 69%, respectively (p = 0.003), whereas the corresponding rates for those with a risk score of ≥3 were 81% and 85%, respectively (p = 0.35).

Conclusions

A single, early instillation of epirubicin after TUR for NMIBC reduces the likelihood of tumour recurrence; however, the benefit seems to be minimal in patients at intermediate or high risk of recurrence. Future trials will determine the value of early instillation in addition to serial instillations in NMIBC.

<ul><li id="aff1">aLund University Hospital, Lund, Sweden</li><li id="aff2">bVäxjö County Hospital, Växjö, Sweden</li><li id="aff3">cLandskrona Hospital, Landskrona, Sweden</li><li id="aff4">dTrelleborg Hospital, Trelleborg, Sweden</li><li id="aff5">eJönköping County Hospital, Jönköping, Sweden</li><li id="aff6">fLjungby Hospital, Ljungby, Sweden</li><li id="aff7">gMalmö University Hospital, Malmö, Sweden</li><li id="aff8">hLund University, Lund, Sweden</li></ul>

2009

1.734

0.0

Kikuchi

, Fujimoto

, Mizutani

, et al. Clinical outcome of tumor recurrence for Ta, T1 non-muscle invasive bladder cancer from the data on registered bladder cancer patients in Japan: 1999-2001 report from the Japanese Urological Association[J]. Int J Urol, 2009, 16(3): 279-286.

1 Working Group of the Bladder Cancer Registration Committee of the Japanese Urological Association, 2 Department of Urology, Keio University School of Medicine, Tokyo, 3 Urology Division, National Cancer Center Hospital, Tokyo, 4 Department of Urology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, 5 Department of Urology, Nara Medical University, Nara, 6 Department of Urology, Faculty of Medical Sciences, Kyushu University, Fukuoka, 7 Urology and Andrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaragi, and 8 Department of Urology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan *Eiji Kikuchi md, Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Email: <a href="mailto:eiji%E2%80%90k@kb3.so%E2%80%90net.ne.jp" title="Link to email address" shape="rect">eiji-k@kb3.so-net.ne.jp</a>

Objective: To characterize the clinical outcome in a large contemporary series of Japanese patients with newly diagnosed Ta, T1 non-muscle invasive bladder cancer who underwent transurethral bladder tumor resection with or without intravesical chemotherapy or Bacillus Calmette-Guérin (BCG) therapy.

... Kikuchi和Frydenberg等^[11,14]报道,肿瘤分期及分级的初次诊断是影响肿瘤复发的危险因素 ...

2011

2.888

0.0

Weizer

, Tallman

, Montgomery

JS.

Long-term outcomes of intravesical therapy for non-muscle invasive bladder cancer[J]. World J Urol, 2011, 29(1): 59-71.

1.Division of Urologic Oncology, Department of Urology, University of Michigan, 7312 CCC, 1500 East Medical Center Dr. SPC 5946, Ann Arbor, MI, 48109-5946, USA

The purpose of the current review was to evaluate the long-term outcomes of intravesical therapy for non-muscle invasive bladder cancer.

... 3 讨论浅表性膀胱癌是膀胱肿瘤中发病率较高的疾病^[1,12],治疗的目的是阻止或延长疾病的进展 ...

2012

1.727

0.0

Okamura

, Akita

, Ando

, et al. Single monthly bacillus Calmette-Guérin intravesical instillation is effective maintenance therapy to prevent recurrence in Japanese patients with non-muscle-invasive bladder cancer[J]. Int J Clin Oncol, 2012, 17(5): 477-481.

1.Department of Urology, J.A. Aichi Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, 446-8602, Japan 2.Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

A series of bacillus Calmette-Guérin (BCG) bladder instillations is the gold standard therapy to prevent recurrence after transurethral resection of bladder tumor (TUR-Bt) of non-muscle-invasive bladder cancer (NMIBC). However, in some cases the outcome is not optimal with the standard 6- to 8-week protocol and therefore interest has focused on additional maintenance therapy. The present study was conducted to assess the utility of single monthly intravesical instillation treatments for up to 1 year in Japanese patients.

<li>1.Department of Urology, J.A. Aichi Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, 446-8602, Japan</li><li>2.Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan</li>

2005

1.5

0.0

Frydenberg

, Millar

, Toner

, et al. Management of superficial bladder cancer in Victoria: 1990 and 1995[J]. ANZ J Surg, 2005, 75(5): 270-274.

1 Monash Medical Centre, 2 The Alfred, 3 Peter MacCallum Cancer Institute, 4 Austin and Repatriation Medical Centre and 5 Cancer Epidemiology Centre, The Cancer Council, Melbourne, Victoria, Australia, * Mark Frydenberg, Chairman, Department of Urology and Clinical Associate Professor, Department of Surgery, Monash University, Monash Medical Centre, Clayton, Vic. 3168, Australia. Email: <a href="mailto:frydenberg@optusnet.com.au" title="Link to email address" shape="rect">frydenberg@optusnet.com.au</a>

Background: A retrospective survey of medical practitioners was undertaken to describe the tumour characteristics, management and outcomes of all superficial bladder cancers newly diagnosed in 1990 and in 1995 in Victoria.

... Kikuchi和Frydenberg等^[11,14]报道,肿瘤分期及分级的初次诊断是影响肿瘤复发的危险因素 ...

2009

0.0

... 亦有报道显示,术后早期灌注化疗药物并不能改善患者的临床预后^[7,15] ...

1994

18.038

0.0

... 对浅表性膀胱肿瘤患者使用化学药物预防治疗,能够增强对膀胱癌患者的长期监测^[16] ...