Bladder Preservation Treatment Program In The Treatment Of Muscle Invasive Bladder Cancer

Objective: Comparison of radical cystectomy and radical transurethral resection of bladder tumor combined with gemcitabine,cisplatin systemic chemotherapy + intravesical chemotherapy in two ways to treat muscle invasive bladder cancer in order to determine the efficacy of bladder preservation treatment program.Methods: Retrospective analysis the clinical data of MIBC patients treated with RC in 23 cases,radical TURBT + GC assisted chemotherapy + intravesical chemotherapy in 41 cases in the First Affiliated Hospital of Henan University of Science and Technology urology between January 2012 and September 2015,telephone follow-up or outpatient follow-up to collect patient follow-up data,excluding data incomplete and lost patients in 8 cases.Twenty patients who received RC therapy were included as the radical group,included the treatment of radical TURBT + GC adjuvant chemotherapy + bladder irrigation chemotherapy bladder treatment of 36 patients,scheduled to bladder preservation group.To compare the two groups of patients with perioperative related indicators,follow-up observation of the two groups of patients with long-term complications,survival and completion of quality of life questionnaire,through statistical methods for two groups of patients perioperative related indicators,long-term complications,EORTC QLQ-C30 and QLQ-BLMC30 were used to evaluate the efficacy of radical TURBT combined with GC systemic chemotherapy plus intravesical chemotherapy for MIBC.Results:1.Operation time 、 Intraoperative blood transfusion,postoperative gastrointestinal recovery time,hospitalization Time had a statistically significant difference between the two groups,bladder preservation group in all aspects of the above was significantly better than the radical group.Comparison of perioperative complications between the radical group and the bladder preservation group: the incidence of common complications and intestinal obstruction had a statistically significant difference.After postoperative bleeding、 infection and fever,incisional hernia,lymphatic leakage.There was no significant difference between the two groups.The bladder preservation group of early complications was lower than that of the radical group.2.The patients were followed up for 3-57 months(mean 29 months).The longterm complications were compared between the two groups.There was no significant difference in postoperative recurrence or metastasis,abdominal incisional hernia and hydronephrosis.In the anastomotic stenosis,repeated urinary tract infection and renal insufficiency,the difference was statistically significant.3.5 patients died in the radical group during the follow-up,2 cases died of multiple organ failure,respectively,died 3 months after surgery and 25 months;3 patients died of postoperative metastasis,12 months after surgery(systemic metastasis),18 months(lung metastasis),28 months(peritoneal metastasis)。 5 patients died in the bladder preservation group,1 died of multiple organ failure at 12 months postoperatively,4 cases died of postoperative metastasis,respectively,after 11 months(lung metastasis),22 months(rectal metastasis),27 months(peritoneal metastasis)41 months(peritoneal metastasis).Kaplan-Meier survival analysis was used to compare the survival status of the two groups.There was no significant difference in the survival curves between the two groups(x2=1.715,P=0.190).The survival rate of the bladder preservation group group was similar to that of the radical group.4.The two groups of EORTC QLQ-C30 and QLQ-BLMC30 scores showed that after treatment,the two groups in the body function,role function,cognitive function,fatigue,nausea and vomiting,shortness of breath,insomnia,loss of appetite,constipation,diarrhea and economic difficulties were no statistically significant difference between the two groups,There were significant differences between the two groups in emotional function,social function,pain,future view,self-image,sexual function and total health field,The score of the bladder preservation group was superior to the radical group in the aspects of emotional function,social function,pain,future view,self-image,sexual function and total health,Indicating that patients of the bladder preservation group in the above areas of life quality was significantly better than the radical group.5.The bladder preservation group of 36 patients were followed up for 11-57 months,an average of 32 months,median follow-up of 29 months.The recurrence rate was 25%(9 cases)within 1 year and 30.5%(11 cases)in 2 years.TURBT was given again for recurrent cases.During the follow-up period,7 patients had multiple recurrence(more than three times),and that patients with multiple relapses were suggested to treat with radical cystectomy,and 4 patients underwent salvage radical surgery.During the follow-up period,a total of 16 patients relapsed,pathological examination found that 9 of them pathology results were downgraded,3 patients with invasive urothelial carcinoma low level rose to high level.Complete remission of 22(61.1%),partial remission(25%),the median overall survival time of 22 months.Conclusion: Radical TURBT combined with GC regimen chemotherapy plus localized intravesical chemotherapy in the treatment of T2N0M0 ~ T3N0M0 MIBC compared with RC,less intraoperative bleeding,rapid postoperative recovery,shortterm and long-term complications,the survival rate during the observation period similar,Better quality of life,worthy of further study.