Comparison Of Curative Effect Between Partial Cystectomy And Radical Cystectomy For Muscle-Invasive Bladder Cancer

SECTION ONE:COMPARISON OF CURATIVE EFFECT BETWEEN PARTIAL CYSTECTOMY AND RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCERObjective To compare the long-term tumor control results of partial cystectomy and radical cystectomy in the treatment of muscle-invasive bladder cancer,and to explore the feasible method of bladder preservation therapy in patients with MIBC.Methods Retrospective analysis was performed on 102 cases of patients with muscle-invasive bladder cancer who underwent partial cystectomy and radical cystectomy in our hospital from January 2012 to December 2018,including 32 cases in the partial cystectomy group and 70 cases in the radical cystectomy group,and the included cases were followed up for a long time.Results All the 102 cases in this study were successfully completed.Partial cystectomy group and Radical cystectomy group Median operating time(169.50(130.00~225.25)min and 420.00(343.75~483.75)min,p<0.001),Median intraoperative blood loss was(100(50~100)ml and 400(200~1000)ml,p<0.001),Median perioperative blood transfusion volume(0(0~0)ml and 600(150.00~906.25)ml,p<0.001),Median total hospital stay(18(14.25~20.00)and 24.5(20.00~34.25)days,p<0.001),Median preoperative preparation time(7(4.25~8.00)and 10(8.00~13.00)days,p<0.001),Median postoperative hospital stay(9(8.00~13.50)and 14(11.00~21.25)days,p<0.001),The incidence of perioperative blood transfusion was(15.6% and 75.7%,p<0.001),The incidence of surgical complications was(28.1%(9/32)and 50.7%(35/69),p=0.033),Average hospitalization cost((26435.76±9877.82)yuan and(58464.36±19753.13)yuan,p<0.001),The differences were statistically significant(p<0.05).Perioperative mortality(0 vs 2.9%(2/70),p=1),and OS at 1,2,3,4,and 5 years after surgery were(80.0%,59.8%,56.1%,51.0%,44.6% vs 76.5%,67.4%,64.9%,57.9%,52.6%,p=0.524),PFS(68.2%,64.6%,60.3%,54.8%,54.8% vs 82.7%,78.3%,75.4%,67.3%,62.1%,p=0.259).DSS(89.9%,72.4%,68.6%,68.6%,62.4% vs 87.3%,83.4%,80.9%,73.6%,68.0%,p=0.424),and the incidence of tumor recurrence or metastasis was(40.0%(12/30)vs 25.4%(16/63),p=0.151),the differences were not statistically significant(p>0.05).Conclusion Strict selection of MIBC patients,partial cystectomy with bladder perfusion therapy can achieve the same tumor control effect as radical cystectomy,but PC has obvious advantages in operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion,preoperative preparation time,total hospital stay,postoperative recovery time,operation cost,surgical complications,etc.For patients with bladder protection needs,this protocol can be considered.SECTION TWO: A META-ANALYSIS OF BCG AND EPIRUBICIN IN THE TREATMENT OF NON-MUSCLE INVASIVE BLADDER CANCER BY INTRAVESICALObjective To compare the efficacy and safety of BCG and EPI in patients with stage T1 or Ta bladder cancer in different populations.Method The Cochrane Library,Pubmed,Embase,Web Of Science,cnki,weipu and wanfang databases were searched by computer from The establishment Of The Cochrane Library to September 2018.All randomized controlled trials comparing BCG and EPI perfusion in The bladder Of patients with Ta and T1 stage bladder cancer were included,without restrictions Of language,race or nationality.The two researchers independently assessed the test’s eligibility,methodological quality,and data extraction.The Rev Man5.2 software was used for a meta-analysis to compare the frequency of tumor recurrence,progression of disease stage,mortality,distant metastasis,local and systemic adverse reactions,and delay or cessation of treatment with risk ratio(RR)and 95% confidence interval(CI).Results A total of 7 trials involving 1,288 patients were included.There were 668 cases in BCG group and 620 cases in EPI group.Baseline characteristics of the seven trials were similar.The results of meta-analysis showed that intravesical BCG infusion in NMIBC patients was more advantageous than EPI in tumor control.Conclusions Intravesical BCG therapy was more effective than EPI in reducing tumor recurrence of Ta and T1 bladder cancer.However,BCG seems to be associated with a higher incidence of drug-induced cystitis,hematuria,and systemic toxicity than EPI.