单次与多次膀胱灌注方案对原发性上尿路尿路上皮癌术后预后的影响

目的: 探讨单次与多次膀胱灌注方案对上尿路尿路上皮癌（UUT-UC）术后患者的疗效和安全性。方法: 收集本院2010年6月至2016年7月收治的原发性上尿路尿路上皮癌术后患者63例，根据化疗方案分为单次膀胱灌注组（SIG）和多次膀胱灌注组（RIG）。比较两组无进展生存期（PFS）、总生存期（OS）和近期毒副反应。结果: 全组随访5～60个月，中位随访36.4个月。SIG和RIG 3年、5年OS分别为65.5%、51.7%和67.6%、52.9%，二者比较差异无统计学意义（P>0.05）；3年、5年PFS分别为79.3%、72.4%和85.3%、76.5%，两组PFS差异有统计学意义（P<0.05）。两组不良反应主要以1～2级的血液学毒性反应和消化道反应为主。RIG在血液学毒性方面发生率明显高于SIG，差异有统计学意义（P<0.05）。消化道反应及膀胱痉挛、膀胱炎方面，RIG高于SIG，两组比较差异有统计学意义（P<0.05）。肝、肾功能损害及发热方面，两组比较差异无统计学意义（P>0.05）。结论: 吡柔比星在UUT-UC术后膀胱预防灌注化疗临床是安全有效的，多次灌注化疗较单次可减少膀胱肿瘤复发率，但不能提高总生存时间。但多次灌注方案引起更严重的消化道反应和血液学毒性反应。

Effect of single and repeated intravesical instillation on prognosis after radical nephroureterectomy in upper urinary tract urothelial carcinoma

AIM: To compare the effect and safety between single intravesical chemotherapy and repeated instillation intravesical after radical nephroureterectomy in upper urinary tract urothelial carcinoma (UUT-UC). METHODS: 63 patients were enrolled after radical nephroureterectomy in upper urinary tract urothelial carcinoma from June 2010 to July 2016, and were divided into two groups according to the chemotherapy protocol. 29 patients in single intravesical group (SIG) and 34 patients in repeted instillation intravesical group (RIG). The progression-free survival, overall survival and side effects between two groups were compared.RESULTS: Follow-up was 5-60 months, media follow-up was 36.4 months. The 3-year and 5-year OS in SIG and RIG were 65.5%, 51.7% and 67.6%, 52.9%, respectively. No significant difference was observed between them(P>0.05). Meanwhile, the 3-year and 5-year PFS in SIG and RIG were 79.3%，72.4% and 85.3%，76.5%, there were significant differences between them(P<0.05). The main side effects of two groups were 1-2 grade hematologic toxicity and gastrointestinal reaction. The incidence of hematologic toxicity, digestive tract reaction, bladder spasm and cystitis in RIG were higher than SIG, there were significant difference among them(P<0.05).However, there were no significant difference between liver or kidney damage and fever(P>0.05).CONCLUSION:Using pirarubicin for intravesical instillation is safe and effective for UUT-UC patients after radical nephroureterectomy. Compared with single instillation, repeated instillation chemotherapy can reduce the recurrence rate of bladder cancer, whilst cannot improve the overall survival. Also, repeated instillation cause more severe gastrointestinal and hematologic toxic reactions.