Department of Urinary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China. NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang, China.
Eur Rev Med Pharmacol Sci. 2024 Mar;28(6):2387-2395. doi: 10.26355/eurrev_202403_35745.
Upper tract urothelial carcinoma (UTUC) is a relatively rare but aggressive type of urologic cancer that includes renal pelvic tumors and ureteral tumors with a poor prognosis. Full-length nephroureterectomy plus sleeve bladder resection is the standard treatment for the disease, but patients are prone to recurrence of bladder tumors after surgery. Intravesical infusion therapy is the main means to prevent the recurrence and progression of bladder cancer. Epirubicin and gemcitabine are widely used in clinical practice as first-line or salvage therapy for intravesical chemotherapy; however, the efficacy of these agents is rarely discussed. The purpose of this study was to investigate the effects of epirubicin and gemcitabine on the occurrence of bladder cancer after radical nephroureterectomy for UTUC and to analyze the risk factors affecting the recurrence of postoperative bladder cancer.
A total of 215 patients with diagnosed UTUC and treated in our hospital from June 2019 to August 2021 were retrospectively selected as the research subjects, and they were divided into an observation group (120 cases) and a control group (95 cases) according to different treatment methods. The patients in the control group were treated with epirubicin, while those in the observation group received gemcitabine. All patients were followed up by telephone or outpatient examination for 12 months to record the occurrence of adverse reactions. The occurrence of bladder cancer was recorded at 3 months, 6 months, and 12 months after the surgery. According to the occurrence of bladder cancer after surgery, the patients were divided into a bladder cancer group (63 cases) and a non-bladder cancer group (152 cases). Multivariate Logistic regression analysis was used to analyze the risk factors of bladder cancer after surgery.
The total incidence of adverse reactions in the control group was 49.47%, which was higher than that in the observation group with 15.00% (p<0.01). The incidence of bladder tumors in the observation group and the control group was 0.00% and 2.11% at 3 months, 5.00% and 8.42% at 6 months, 13.33% and 15.79% at 12 months, without significant difference (p>0.05). After 12 months of perfusion, the levels of acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) in the two groups were significantly lower than those before perfusion (p<0.05). In the observation group, the levels of these three factors were slightly decreased compared with those in the control group, without a significant difference (p>0.05). Between the bladder cancer and non-bladder cancer groups, there were significant differences in tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer (p<0.05). The above indexes were all risk factors for postoperative bladder cancer (p<0.05).
Epirubicin and gemcitabine reduced the occurrence of bladder cancer and effectively inhibited tumor angiogenesis after radical nephroureterectomy for UTUC. The tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer were risk factors for postoperative bladder cancer.
上尿路尿路上皮癌（UTUC）是一种相对罕见但具有侵袭性的泌尿系统癌症，包括肾盂肿瘤和输尿管肿瘤，预后较差。根治性肾输尿管切除术加袖状膀胱切除术是该病的标准治疗方法，但患者术后易复发膀胱癌。膀胱内灌注治疗是预防膀胱癌复发和进展的主要手段。表柔比星和吉西他滨广泛应用于临床一线或挽救性膀胱内化疗；然而，这些药物的疗效很少被讨论。本研究旨在探讨表柔比星和吉西他滨对根治性肾输尿管切除术后 UTUC 患者膀胱癌发生的影响，并分析影响术后膀胱癌复发的相关因素。
回顾性选择 2019 年 6 月至 2021 年 8 月在我院治疗的 215 例确诊为 UTUC 患者作为研究对象，根据不同的治疗方法分为观察组（120 例）和对照组（95 例）。对照组患者接受表柔比星治疗，观察组患者接受吉西他滨治疗。所有患者均通过电话或门诊检查进行为期 12 个月的随访，记录不良反应的发生情况。术后 3 个月、6 个月和 12 个月记录膀胱癌的发生情况。根据术后膀胱癌的发生情况，将患者分为膀胱癌组（63 例）和非膀胱癌组（152 例）。采用多因素 Logistic 回归分析术后膀胱癌的危险因素。
对照组总不良反应发生率为 49.47%，高于观察组的 15.00%（p<0.01）。观察组和对照组术后 3 个月、6 个月、12 个月膀胱肿瘤的发生率分别为 0.00%和 2.11%、5.00%和 8.42%、13.33%和 15.79%，差异无统计学意义（p>0.05）。灌注后 12 个月，两组患者酸性成纤维细胞生长因子（aFGF）、碱性成纤维细胞生长因子（bFGF）和血管内皮生长因子（VEGF）水平均明显低于灌注前（p<0.05）。观察组上述三种因子的水平较对照组略有下降，但差异无统计学意义（p>0.05）。膀胱癌组和非膀胱癌组在肿瘤位置、病灶数量、肿瘤分期、术前输尿管检查和术前膀胱癌史方面存在显著差异（p<0.05）。以上指标均为术后膀胱癌的危险因素（p<0.05）。
表柔比星和吉西他滨降低了根治性肾输尿管切除术后 UTUC 患者膀胱癌的发生，并有效抑制了肿瘤血管生成。肿瘤位置、病灶数量、肿瘤分期、术前输尿管检查和术前膀胱癌史是术后膀胱癌的危险因素。
