Comparison Of The Efficacy Of Gemcitabine And Epirubicin Intravesical Chemotherapy In The Treatment Of Bladder Cancer

Objective:To compare the efficacy and analyze the potential prognostic risk factors of adjuvant intravesical chemotherapy conducted by instillations of gemcitabine and epirubicin in the treatment of intermediate-and high-risk non-muscular invasive bladder cancer.Methods:The clinical data of patients with non-muscular invasive bladder cancer who underwent transurethral resection of bladder tumor in our hospital from January 1,2015 to December 31,2018 were analyzed retrospectively.Combining with the postoperative pathology,tumor size,tumor number and other clinical data which could evaluate the risk of tumor’s recurrence and progression,we recognize the patients with intermediate-and high-risk non-muscular invasive bladder cancer.According to the postoperative instillation of drugs,the patients were divided into group of gemcitabine and group of epirubicin.In this study,129 men and 42 women were included;33 patients with tumor recurrence and progression were classified as intermediaterisk and 138 high-risk patients.There were 79 patients in gemcitabine group in which 15 patients belong to intermediate risk and 64 patients belong to high risk.There were 92 patients in epirubicin treatment group in which 18 patients belong to medium risk and 74 patients belong to high risk.To compare the efficacy of gemcitabine and epirubicin in the treatment of intermediate-and high-risk non-muscular invasive bladder cancer,we collect the information of whether the tumor recurs and the time of recurrence after operation.At the same time,the correlation between the prognosis and the factors such as age,sex,postoperative pathology,tumor size,number of tumors,single instillation and bladder irrigation were analyzed.Results:The 1-year relapse-free survival rate was 87.34%(69 / 79)in the gemcitabine group and88.04%(81 / 92)(P> 0.05)in the epirubicin group.There was no significant difference in oneyear Kaplan-Meier relapse-free survival curve between the two groups(P> 0.05).During the follow-up period,the overall relapse-free survival rate in the gemcitabine group was 69.62%(55 / 79),and in the epirubicin group was 78.26%(72 / 92)(P> 0.05).During the follow-up period,there was no significant difference in the total Kaplan-Meier relapse-free survival curve between the two groups(P> 0.05).In gemcitabine group: univariate Cox analysis showed that the risk of recurrence in patients ≥3 tumors was 3.199 times higher than that in patients with a tumor(OR3.199,95%CI: 1.355～7.551).In epirubicin group: univariate Cox analysis showed that the risk of recurrence in patients ≥3 tumors was 3.035 times higher than that in patients with a tumor(OR3.035,95%CI:1.052～8.755).Multivariate Cox analysis showed that the risk of recurrence in patient ≥3 tumors was 3.585 times higher than that in patients with a tumor(OR3.585,95%CI:1.237～10.387).In epirubicin group: univariate Cox analysis showed that the risk of recurrence in patients with stage T1 was 4.667 times higher than that in patients with stage Ta(OR4.667,95%CI:1.366～15.949),while multivariate Cox analysis showed that the risk of recurrence in patients with stage T1 was 5.106 times higher than that in patients with stage Ta(OR5.106,95%CI:1.441～18.095).In epirubicin group: univariate Cox analysis showed that the risk of recurrence in patients without continuous saline bladder irrigation after operation was 3.396 times higher than that in patients with continuous saline bladder irrigation(OR3.396,95%CI:1.133～10.175).Multivariate Cox analysis showed that the risk of recurrence in patients without continuous saline bladder irrigation was 3.093 times higher than that in patients with continuous saline bladder irrigation(OR3.093,95% CI:1.013～9.446).Conclusion:(1)There is no difference in tumor recurrence between patients with intermediate-and high-risk non-muscular invasive bladder cancer adjuvant intravesical chemotherapy instillations with epirubicin or gemcitabine.(2)Whether adjuvant intravesical chemotherapy conducted by instillations of gemcitabine or epirubicin,the number of bladder cancer ≥ 3 is a risk factor for cancer recurrence.(3)In patients whose intravesical chemotherapy conducted by instillations of epirubicin,T1 stage is a risk factor for recurrence compared with Ta stage.Postoperative continuous bladder irrigation >8h can reduce the risk of tumor recurrence.