吡柔比星与羟基喜树碱对浅表性膀胱癌的预防及安全性的meta分析

Meta-analysis on the Prevention and Safty of Pirarubicin and Hydroxycamptothecin in the Treatment of Superficial Bladder Cancer

关键词:  膀胱肿瘤  羟基喜树碱  吡柔比星  meta分析

Key words:  bladder tumor  hydroxycamptothecin  pirarubicin  meta analysis

摘要:

目的 比较吡柔比星（pirarubicin，THP）与羟基喜树碱（hydroxycamptothecin，HCPT）膀胱灌注对膀胱癌复发的预防作用及安全性。方法 收集关于THP与HCPT膀胱灌注治疗膀胱癌的比较性研究文献，进行系统分析。采用相对危险度（RR）及95%可信区间（CI）作为评价比较疗效及毒性差异的指标。统计软件为RevMan 5.3。结果 共入选18项临床研究包括1 597名患者，其中822例接受THP治疗，775例接受HCPT治疗。Meta分析结果提示，THP组与HCPT组6个月复发率无统计学差异[RR=0.69，95% CI（0.47，1.02），P>0.05]，9个月复发率无统计学差异[RR=0.80，95% CI（0.42，1.54），P>0.05]，而THP组1年内复发率低于HCPT组[RR=0.74，95% CI（0.56，0.99），P<0.05]，2年内复发率也低于HCPT组[RR=0.74，95% CI（0.61，0.92），P<0.01]。2组间的膀胱刺激症状、血象无显著性差异；2组膀胱灌注预防血尿发生率的差异有统计学意义[RR=1.74，95% CI（1.11，2.72），P=0.02]，HCPT组血尿发生率低于THP组。结论 THP与HCPT对肿瘤复发率的控制灌注后约6，9个月无明显差异，1年和2年THP组的复发率小于HCPT组，但血尿发生率高于HCPT组。在可以耐住不良反应的前提下，优选THP。

Abstract:

OBJECTIVE To compare the preventive and therapeutic effects of intravesical instillation of pirarubicin (THP) and hydroxycamptothecin (HCPT) on recurrence of bladder cancer.METHODS A comparative study of THP and HCPT intravesical instillation for the treatment of bladder cancer was performed and analyzed systematically.Relative risk (RR) and 95% confidence interval (CI) were used to evaluate the efficacy and toxicity differences.The statistical software was RevMan 5.3.RESULTS A total of 18 clinical studies included 1 597 patients,of which 822 received THP treatment,775 received HCPT treatment were analyzed.Meta-analysis showed that there was no significant difference in recurrence rate between THP group and HCPT group at 6 months[RR=0.69,95% CI (0.47,1.02),P>0.05],and the recurrence rate was not statistically significant at 9 months[RR=0.80,95% CI (0.42,1.54),P>0.05].The relapse rate in THP group was lower than that in HCPT group at one year[RR=0.74,95% CI (0.56,0.99),P<0.05],also lower than HCPT group at two years[RR=0.74,95% CI (0.61,0.92),P<0.01].There was no significant difference between the two groups in the symptoms of bladder irritation and hemogram.There was significant difference in the incidence of urinary incontinence between the two groups[RR=1.74,95% CI (1.11,2 72)P=0.02].The incidence of hematuria in the HCPT group was lower than that in the THP group.CONCLUSION There is no significant difference in the recurrence rate between THP and HCPT for about 6 and 9 months after infusion.In the long term,the recurrence rate of THP in one year and two years is less than that in HCPT,while the incidence of hematuria in the HCPT group is lower than that in the THP group (P<0.05).THP is preferred in that it is resistant to adverse reactions.