医学
吡柔比星
表阿霉素
膀胱癌
噻替帕
化疗
阶段(地层学)
随机对照试验
丝裂霉素C
外科
优势比
泌尿科
癌症
内科学
环磷酰胺
古生物学
生物
作者
Richard Sylvester,Willem Oosterlinck,A.P.M. van der Meijden
出处
期刊:The Journal of Urology
[Ovid Technologies (Wolters Kluwer)]
日期:2004-06-01
卷期号:171 (6 Part 1): 2186-2190
被引量:647
标识
DOI:10.1097/01.ju.0000125486.92260.b2
摘要
We determined if 1 immediate instillation of chemotherapy after transurethral resection (TUR) decreases the risk of recurrence in patients with stage Ta T1 single and multiple bladder cancer overall and separately.A meta-analysis was performed of the published results of randomized clinical trials comparing TUR alone to TUR plus 1 immediate instillation of chemotherapy.Our study included 7 randomized trials with recurrence information on 1476 patients. Based on a median followup of 3.4 years and a maximum of 14.5 years, 267 of 728 patients (36.7%) receiving 1 postoperative instillation of epirubicin, mitomycin C, thiotepa or (2'R)-4'-O-tetrahydropyranyl-doxorubicin (pirarubicin) had recurrence compared to 362 of 748 patients (48.4%) with TUR alone, a decrease of 39% in the odds of recurrence with chemotherapy (OR 0.61, p <0.0001). Patients with a single tumor (OR 0.61) and those with multiple tumors (OR 0.44) benefited. However, after 1 instillation 65.2% of patients with multiple tumors had recurrence compared to 35.8% of patients with single tumors, showing that 1 instillation alone is insufficient treatment for patients with multiple tumors.One immediate intravesical instillation of chemotherapy significantly decreases the risk of recurrence after TUR in patients with stage Ta T1 single and multiple bladder cancer. It is the treatment of choice in patients with a single, low risk papillary tumor and is recommended as the initial treatment after TUR in patients with higher risk tumors.
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