Therapeutic Effect Of Chemohyperthermia On Non-muscle Invasive Bladder Cancer And Predictive Roles Of Its Prognosis By The Peripheral Blood Indicators

Background: Cancer has always been the biggest threat to human health.As one of the most common tumors in the urinary system,bladder cancer has always attracted people’s attention because of its high incidence rate and high mortality.How to prevent the occurrence of bladder cancer,reduce the recurrence of bladder cancer,and improve the prognosis of patients has become one of the key topics of urinary health.The most common type of bladder cancer,non-muscle invasive bladder cancer(NMIBC),has a high recurrence rate and progression rate for many years.The current gold standard treatment plan is surgical treatment(transurethral resection of bladder lesions)supplemented by postoperative bladder perfusion chemotherapy or BCG bladder perfusion therapy.In recent years,in order to reduce its recurrence rate and progression rate,new clinical research and practical application of postoperative adjuvant therapy have emerged,including bladder hot perfusion chemotherapy(CHT),electric drug delivery,systemic drug delivery and local heating.Because the inflammatory reaction induced by tumor tissue and immune system plays an important role in the occurrence and development of tumors,combined with the characteristics of easy access to peripheral blood,the prognostic value of peripheral blood indicators in tumors has been gradually discovered and valued by scholars in recent years.Combined with literature reading and clinical findings,this study selected three peripheral blood inflammation indicators: platelet/lymphocyte ratio(PLR),systemic immune inflammation index(SII),and mean platelet volume/lymphocyte ratio(MPVLR).Objective: On the one hand,this study explored the clinical efficacy and feasibility of bladder hyperthermic perfusion chemotherapy by comparing patients with conventional bladder perfusion chemotherapy and patients with bladder hyperthermic perfusion chemotherapy;On the other hand,we explored whether the three peripheral blood inflammatory indicators,PLR,SII and MPVLR,calculated by the routine blood indicators within one week before surgery,have predictive value for the recurrence of NMIBC after surgery,and compared whether the three indicators have different predictive effects on the recurrence of NMIBC after surgery when using bladder hyperthermic perfusion chemotherapy or conventional bladder perfusion chemotherapy,so as to speculate the possible mechanism of bladder hyperthermic perfusion chemotherapy.Subjects and Methods: 222 subjects were included through the inclusion and exclusion criteria set in this study,including 149 NMIBC patients from the Second Hospital of Lanzhou University,who were treated with routine bladder perfusion chemotherapy(GEM group)after surgery,and 73 NMIBC patients from Wuwei Cancer Hospital in Gansu Province,who were treated with bladder hyperthermic perfusion chemotherapy(CHT group)after surgery.The clinical data of the subjects were collected,including gender,age,operation date,contact information,number of tumors,tumor size,tumor T stage,nuclear grading,perfusion drugs,perfusion time,and peripheral blood indexes measured within 1 week before operation.The primary end point of follow-up was tumor recurrence or tumor progression,and the recurrence time,progression time,and adverse reaction rate.Carry out statistical analysis on the data obtained.Results: Compared with GEM group,RFS(P=0.033)and PFS(P=0.027)in CHT group were better,and the difference was statistically significant;The recurrence time of CHT group was later than that of GEM group,and the difference was statistically significant;The progress time of CHT group was earlier than that of GEM group,but the difference was not statistically significant;Compared with pirarubicin(THPCHT group),gemcitabine(GEMCHT group)and pirarubicin(THPCHT group)used in bladder hyperthermic perfusion chemotherapy had better RFS,but the difference was not statistically significant(p=0.166).The recurrence time of GEMCHT group was later than that of THPGEM group,but the difference was not statistically significant(p=0.296);In terms of adverse reactions,there is no significant difference between hot perfusion chemotherapy and conventional perfusion chemotherapy,and there is no statistically significant difference in the incidence of various adverse reactions and the total incidence between the GEMCHT group and the THPCHT group.The research results of peripheral blood indicators reflect that: for conventional bladder perfusion chemotherapy,high PLR,high SII,and high MPVLR indicate lower RFS;for patients with bladder CHT,high PLR and high SII indicate lower RFS,while MPVLR is not related to the prognosis of patients with bladder CHT.Conclusion: As a safe and effective adjuvant therapy,bladder CHT can significantly reduce the recurrence rate of tumor and delay and inhibit tumor progression.Compared with THP,GEM has a trend of better efficacy in hyperthermia.The high PLR,SII and MPVLR values in patients with conventional perfusion chemotherapy suggest a higher possibility of recurrence,and the high PLR and SII values in patients with bladder CHT also indicate a poor prognosis.Bladder CHT can affect the effect of platelets in patients’ blood on tumor through a certain mechanism,and then play a role in inhibiting tumor,but the specific mechanism needs more experiments to explore.