Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to a...Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.展开更多
目的验证欧洲癌症研究与治疗组织（European Organization for Research and Treatment of Cancer，EORTC）膀胱癌预后风险评分表对我国非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）患者预后判断的准确性。方法按...目的验证欧洲癌症研究与治疗组织（European Organization for Research and Treatment of Cancer，EORTC）膀胱癌预后风险评分表对我国非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）患者预后判断的准确性。方法按照EORTC评分标准对225例NMIBC患者进行评分并按得分高低分组，寿命表法计算每组患者的1年和5年实际复发率及进展率，LogRank检验行组间比较并与EORTC评分表相应结果对比。多因素分析筛选影响NMIBC预后的独立因素。结果低、中、高复发风险者分别32、109、84例，低、中、高进展风险者分别25、128、72例。低、中、高复发及进展风险组术后1年复发率和进展率分别为15．1％、31．2％、55．5％和0．3％、2．0％、15．5％；术后5年复发率和进展率分别为28．2％、55．2％、75．0％和1．4％、12．9％、54．7％。除高进展风险组5年进展率略高外，其余均接近EORTC评分表。各组间相比，复发率及进展率的差异有统计学意义（P〈0．01）。多因素分析表明，EORTC评分为影响NMIBC患者术后复发及进展风险的独立因素（P〈0．01）。结论EORTC风险评估表使用简便，可以按照复发及进展风险概率将患者准确分层，值得推广应用。展开更多
Background Immediate intravesical instillation of chemotherapeutic agents after transurethral resection （TUR） of non- muscle invasive transitional cell bladder cancer has recently been suggested and has been proven ...Background Immediate intravesical instillation of chemotherapeutic agents after transurethral resection （TUR） of non- muscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly. This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin （THP~） as prophylaxis compared to regular instillations only after TUR operation. Methods This was a prospective, randomized, multi-center, clinical study. Patients diagnosed with non-muscle invasive bladder cancer （Ta and T1） pathologically and suitable for TUR were enrolled randomly into two groups. In the study group, the patients received intravesical instillation within 24-hour post TURBT, followed by regular intravesical therapy using 30 mg/50 ml of THP~ once a week for 8 weeks, and then once a month to 1 year postoperatively Among the patients. In the control group, patients received regular instillation only. Results A total of 403 patients were enrolled into this study from 26 institutions in China. Among the potients, 210 were enrolled into the study group and 193 were enrolled into the control group. At the median follow-up of 18 months, the recurrence rate was 7.8% in the study group, significantly lower than that in the control group （14.3%; P=0.042）. Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group （6.8%） than in the control group （14.0%; P=0.047）, although no significant differences were found in high-risk patients. Conclusion One immediate dose of THP 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence, especially in low and intermediate-risk patients.展开更多
目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于...目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于上海市第一人民医院泌尿外科中心行TLEBRBT且术后病理提示NMIBC的共计104例患者,配合术中即刻膀胱灌注吡柔比星。回顾性分析患者的手术时间、术中出血量、术中术后并发症、导尿管留置天数、术后病理分期分级。随访患者复发及进展情况并依据病理分级与分期分层统计患者复发率。结果:104例患者均行TLEBRBT,手术时间15~60min,平均(35.71±9.16)min;术中少量出血,无闭孔神经反射及膀胱穿孔发生,留置导尿1~4d。术后病理分期Ta74例,T130例。临床病理分级低度恶性潜能(PUNLMP)16例,低级别70例,高级别18例。随访时间6~35.5个月,平均(25.05±9.97)个月;复发13例(12.5%),平均复发时间(9.65±8.46)个月,死亡2例(1.9%)。结论:TLEBRBT配合术中膀胱灌治疗NMIBC安全、疗效确切、术后病理精确,是一种理想的手术治疗方式。展开更多
文摘Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.
文摘目的探讨经尿道等离子膀胱肿瘤切除（plasmakinetic resection of bladder tumor,PKRBt）术中经膀胱黏膜下多点注射吉西他滨治疗非前壁的非肌层浸润性膀胱癌（non muscle-invasive bladder cancer,NMIBC）的临床疗效。方法我院2012年1月-2013年10月经膀胱镜下组织活检病理确诊的非前壁的NMIBC患者90例,按随机数字表法分为观察组和对照组,每组45例。对照组行PKRBt,观察组PKRBt术中经膀胱黏膜下多点注射吉西他滨5 ml（25 mg/ml）。2组术后维持膀胱灌注化疗相同。比较2组术后肿瘤复发率,免疫荧光杂交技术检测（fluorescence in situ hybridization,FISH）阳性复发率及术后不良反应发生率,并用生活质量综合评定问卷（Generic Quality of Life Inventory-74,GQOLI-74）对2组治疗后1年的生活质量做出评价。结果 1、1.5、2年无肿瘤复发生存率观察组分别为93.3%、91.1%,89.9%,对照组为88.9%、75.1%,65.7%（log rankχ^2=6.476,P=0.011）;1、1.5、2年无FISH复发生存率观察组分别为93.3%、86.7%,84.4%,对照组为91.1%、68.3%,61.2%（log rankχ^2=5.883,P=0.015）。术后2组均有不同程度的尿路刺激症状、轻度肾功能损伤及胃肠道反应,2组不良反应发生率无显著性差异（P〉0.05）。观察组治疗1年后躯体功能、心理功能、社会功能、物质生活四个维度得分均较对照组高（P〈0.05）。结论对于非前壁NMIBC,PKRBt术中经膀胱黏膜下多点注射吉西他滨可以显著降低复发率,不良反应少,安全性高,术后生活质量高,值得在临床推广应用。
文摘目的验证欧洲癌症研究与治疗组织（European Organization for Research and Treatment of Cancer，EORTC）膀胱癌预后风险评分表对我国非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）患者预后判断的准确性。方法按照EORTC评分标准对225例NMIBC患者进行评分并按得分高低分组，寿命表法计算每组患者的1年和5年实际复发率及进展率，LogRank检验行组间比较并与EORTC评分表相应结果对比。多因素分析筛选影响NMIBC预后的独立因素。结果低、中、高复发风险者分别32、109、84例，低、中、高进展风险者分别25、128、72例。低、中、高复发及进展风险组术后1年复发率和进展率分别为15．1％、31．2％、55．5％和0．3％、2．0％、15．5％；术后5年复发率和进展率分别为28．2％、55．2％、75．0％和1．4％、12．9％、54．7％。除高进展风险组5年进展率略高外，其余均接近EORTC评分表。各组间相比，复发率及进展率的差异有统计学意义（P〈0．01）。多因素分析表明，EORTC评分为影响NMIBC患者术后复发及进展风险的独立因素（P〈0．01）。结论EORTC风险评估表使用简便，可以按照复发及进展风险概率将患者准确分层，值得推广应用。
文摘Background Immediate intravesical instillation of chemotherapeutic agents after transurethral resection （TUR） of non- muscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly. This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin （THP~） as prophylaxis compared to regular instillations only after TUR operation. Methods This was a prospective, randomized, multi-center, clinical study. Patients diagnosed with non-muscle invasive bladder cancer （Ta and T1） pathologically and suitable for TUR were enrolled randomly into two groups. In the study group, the patients received intravesical instillation within 24-hour post TURBT, followed by regular intravesical therapy using 30 mg/50 ml of THP~ once a week for 8 weeks, and then once a month to 1 year postoperatively Among the patients. In the control group, patients received regular instillation only. Results A total of 403 patients were enrolled into this study from 26 institutions in China. Among the potients, 210 were enrolled into the study group and 193 were enrolled into the control group. At the median follow-up of 18 months, the recurrence rate was 7.8% in the study group, significantly lower than that in the control group （14.3%; P=0.042）. Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group （6.8%） than in the control group （14.0%; P=0.047）, although no significant differences were found in high-risk patients. Conclusion One immediate dose of THP 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence, especially in low and intermediate-risk patients.
文摘目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于上海市第一人民医院泌尿外科中心行TLEBRBT且术后病理提示NMIBC的共计104例患者,配合术中即刻膀胱灌注吡柔比星。回顾性分析患者的手术时间、术中出血量、术中术后并发症、导尿管留置天数、术后病理分期分级。随访患者复发及进展情况并依据病理分级与分期分层统计患者复发率。结果:104例患者均行TLEBRBT,手术时间15~60min,平均(35.71±9.16)min;术中少量出血,无闭孔神经反射及膀胱穿孔发生,留置导尿1~4d。术后病理分期Ta74例,T130例。临床病理分级低度恶性潜能(PUNLMP)16例,低级别70例,高级别18例。随访时间6~35.5个月,平均(25.05±9.97)个月;复发13例(12.5%),平均复发时间(9.65±8.46)个月,死亡2例(1.9%)。结论:TLEBRBT配合术中膀胱灌治疗NMIBC安全、疗效确切、术后病理精确,是一种理想的手术治疗方式。
