Clinical Effect Of Radical TUR-BT Combined With Intra-arterial Chemotheracpy For Localized Muscle-invasive Bladder Cancer

Objective:To evaluate the clinical efficacy of Radical TUR-BT combined with intra-arterial chemotherapy in the treatment of stage T₂N₀M₀ localized muscle-invasive bladder cancer.Methods:The survival data of 91 patients with stage T₂N₀M₀muscle-invasive bladder cancer paients from January 2010 to December 2015 were retrospectively analyzed.According to different surgical methods,it was divided into bladder-preserving therapy?BPT?group?n=34?:Accepting Radical TUR-BT+bilateral intra-arterial chemotherapy;Radical cystectomy?RC?treatment group?n=57?:Underwent radical cystectomy+urinary diversion,Urinary diversion includes reconstruction of bladder with ileum or cutaneous ureterostomy,patients did not receive adjuvant chemotherapy or chemotherapy after surgery.The median follow-up time,disease-specific survival rate,2-year progression-free survival,overall survival and final outcome,arterial chemotherapy side effects,and adverse reactions were compared between the two groups.Measurement data were expressed as mean±standard deviation?x?s?,t test was used for comparison between groups;count data was expressed in terms of rate,and?² test was used to compare differences.Using Kaplan-Meier method to depict disease-specific survival time in two groups.Quality of life evaluation using Karnofsky score,Evaluate the quality of life and health status of the two groups 3 months before and after treatment.Results:The BPT group was followed up for 3 to 96 months,with a median follow-up of 35 months and tumor recurrence in 11 patients.The RC group was followed up for 1 to 96 months,the median follow-up time was 33 months,and the tumor recurred in 15 cases.The overall survival rates of the two groups were 61.8%and 63.2%,respectively,and the difference was not statistically significant?P=0.103?.The 2-year progression-free rates in the BPT and RC groups were 73.5%and 75.4%,and the difference was not statistically significant?P=0.758?.The 5-year disease-specific survival rates of the two groups were 72.4%and74.8%,respectively,and the difference was not statistically significant?P=0.780?.There was no significant difference in preoperative KPS score between the BPT group and the RC group.The KPS score of the BPT group was significantly higher than that of the RC group at 3 months after surgery?P=0.034?.During arterial chemotherapy,The gastrointestinal reactions of I,II,and III were 7?20.6%?,5?14.7%?,and 2?5.9%?.The toxicities of blood system I,II and III were 5?14.7%?,2?5.9%?and 1?2.9%?,1 case?2.9%?showed liver damage,Alleviated after symptomatic treatment.No patients had obvious renal function damage,heart function,and nervous system damage.Conclusion:For patients with localized invasive bladder cancer with clinical stage of T_2a^T_2bN₀M_0,The number of tumor lesions?3,and tumor margins>2 cm from ureteral opening,Radical TUR-BT combined with intra-arterial chemotherapy has similar effects to RC.This treatment can effectively improve the prognosis,preserve the bladder,and improve the quality of life for patients.