摘要
背景与目的:膀胱癌是泌尿系最常见的恶性肿瘤。对于非肌层浸润性膀胱癌,术后腔内灌注是预防其复发的重要措施。卡介苗被认为是最有效的免疫治疗制剂,而表柔比星是已报道肿瘤完全缓解率较高的灌注化疗药物。但两种制剂在膀胱癌的疗效比较尚无定论。本文收集相关资料,以期比较表柔比星、卡介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发、疾病进展的疗效和副作用。方法:按文中所述纳入标准,检索国内外已公开发表的关于表柔比星、卡介苗膀胱灌注治疗非肌层浸润性膀胱癌的比较性研究文献,并应用Revman4.2软件进行数据处理和分析。结果:共有6个研究符合标准被纳入,涉及总病例数1288例,其中表柔比星灌注治疗657例,复发253例;卡介苗治疗631例,复发184例。Meta分析结果提示卡介苗预防复发的疗效优于表柔比星,且统计学差异有显著性(PetoOR=1.60,95%CI=[1.26,2.03],P=0.0001);在预防疾病进展方面,卡介苗同样优于表柔比星(PetoOR=1.70,95%CI=[1.16,2.49],P=0.006);5个研究报道了药物主要局部副作用的比较,Meta分析显示表柔比星组在血尿(PetoOR=0.47,95%CI=[0.35,0.62],P<0.00001)、膀胱炎/膀胱刺激症(PetoOR=0.23,95%CI=[0.11,0.48],P<0.0001)发生率上显著低于卡介苗组。结论:卡介苗膀胱灌注预防非肌层浸润性膀胱癌术后复发及疾病进展作用优于表柔比星,但副作用发生率明显升高,选择病例需谨慎。
Background and purpose： Bladder carcinoma is the most common tumor in the urogenital system in China. For patients with non-invasive bladder cancer, intravesical therapy is an important part of treatment after complete transurethral resection （ TURBt）. Bacillus Calmette-Guerin （BCG） remains the most effectivelv used immune agent, and epirubicin （EPI） has been reported to have an improved antitumor activity and high remission rate. However. the results differed significantly from study to study, To compare the efficacy and treatment-induced side effects of intravesieal epirubicin versus BCG on postoperative recurrence of non-invasive bladder carcinoma, we completed a meta-analvsis of the published literature. Methods： According to the criteria in the paper, we retrieved published comparative studies on intravesical epirubicin versus BCG for non-invasive bladder carcinoma. Data were extracted from each identified paper and Revman4.2 software was used for statistical analysis. Results： 6 trials including 1 288 patients were eligible according to the eligibility criteria. Of 657 cases that were treated with epirubicin and 631 with BCG, recurrence occurred in 253 and 184 respectively. Pooling data of a meta-analysis indicated that BCG statistically reduced the incidence of tumor recurrence （ Peto OR = 1.60, 95% CI = [ 1.26, 2.03], P = 0. 000 1）. With regard to tumor progression, BCG was also statistically superior to epirubicin （ Peto OR = 1.70, 95% CI = [ 1.16, 2.49], P =0. 006）. 5 studies reported the comparison on main local side effects in terms of hematuria, cystitis or irritative symptoms. Combined results showed that the incidence of hematuria （Peto OR = 0. 47, 95% CI=[0.35, 0,62], P〈0. 00001） and cystitis/irritativesymptoms （OR =0.23, 95%CI=[0.11, 0.48], P〈0. 000 1） were significantly lower in the epirubiein group, Conclusions： Intravesically administered BCG after operation in the patients with non-invasive bladder carcinoma may reduce the incidence of tumor recurrence and prevent progression. However, the side effects of BCG therapy are significantly higher compared to the group treated by epirubicin therapy.
出处
《中国癌症杂志》
CAS
CSCD
2007年第3期240-244,共5页
China Oncology
关键词
表柔比星
卡介苗
膀胱肿瘤
荟萃分析
epirubicin
bacillus Calmette-Guerin
bladder necplasms
meta-analysis
