2020 年第 9 期 第 15 卷

卡介苗膀胱灌注治疗中高危非肌层浸润性膀胱癌的临床效果及影响因素

Clinical effect and influencing factors on non-muscular invasive bladder carcinoma with intermediate-high risk treated with bacillus calmette-guérin bladder irrigation

作者：何叶叠徐一鹏王华

英文作者：He Yedie Xu Yipeng Wang Hua

单位：中国科学院大学附属肿瘤医院泌尿外科，杭州310022 

英文单位：Department of Urology Surgery Cancer Hospital of The University of Chinese Academy of Sciences Hangzhou 310022 China

关键词：非肌层浸润性膀胱癌；卡介苗；膀胱灌注；肿瘤复发 

英文关键词：Non-muscularinvasivebladdercarcinoma;Bacilluscalmette-guérin;Intravesicalperfusion;Tumorrecurrence 

• 摘要：

• 目的 探讨卡介苗膀胱灌注治疗对于中高危非肌层浸润性膀胱癌（NMIBC）患者的临床效果，并对其影响因素作初步评估。方法 收集2015年12月至2019年9月在中国科学院大学附属肿瘤医院进行手术治疗并由术后病理证实的38例中高危NMIBC患者的临床资料，年龄50~74岁，平均（62±6）岁，其中男30例、女8例。所有患者术后予卡介苗膀胱灌注治疗，总灌注时长为1年，共19次，定期进行复查，记录患者的复发及进展数据，并进行统计学分析。结果 38例患者中位随访时间28（6，46）个月，所有患者在灌注过程中均未出现药物不耐受或严重不良反应。随访期间共12例（31.6%）患者出现肿瘤复发，4例（10.5%）患者出现疾病进展，其中2例为T2期复发，2例为T3期复发，中位复发时间为10.5（6.0，18.0）个月；12例复发的患者中共9例接受了根治性膀胱全切手术治疗。灌注后1年无复发生存率为81.6%（31/38）。肿瘤的病理分期（P=0.018）、病理分级（P=0.012）以及既往膀胱癌病史（P=0.020）与灌注后复发具有相关性。结论 卡介苗膀胱灌注治疗对于中高危NMIBC患者短期内疗效明确，患者的病理学特征以及既往复发病史可能与卡介苗治疗后复发有关。

• Objective To explore the efficacy of bacillus calmette-guérin(BCG) bladder irrigation therapy in patients with intermediate-high risk non-muscular invasive bladder cancer(NMIBC) after surgery, and to evaluate its influencing factors. Methods From December 2015 to September 2019， the clinical data of 38 patients with middle- and high-risk NMIBC who received surgical treatment and were confirmed by postoperative pathology in the Cancer Hospital of The University of Chinese Academy of Sciences were collected. The mean age was (62±6)years (50-74 years), with 30 males, 8 females. All patients were treated with BCG bladder perfusion after surgery, with a total perfusion duration of 1 year and 19 times in total. Regular reexamination was carried out to record the recurrence and progress data of the patients, and statistical analysis was carried out. Results The median follow-up time of 38 patients was 28 (6,46) months. No drug intolerance or serious adverse reactions occurred in all patients during perfusion. During the follow-up period, tumor recurrence occurred in 12 patients (31.6%) and disease progression occurred in 4 patients (10.5%), including 2 patients with T2 stage recurrence and 2 patients with T3 stage recurrence. The median recurrence time was 10.5 (6.0, 18.0) months and 9 patients received radical cystectomy. After perfusion, the 1-year recurrence-free survival rate was 81.6% (31/38). The pathological stage (P=0.018), the pathological grade (P=0.012) and the previous history of bladder cancer (P=0.020) were correlated with the recurrence after perfusion. Conclusions Bladder instillation of BCG is effective for patients with medium and high risk of NMIBC in a short time. The pathological features and previous history of recurrence may be related to recurrence after BCG treatment.