| Background and purposeBladder Cancer(BC)is the most common malignant tumor of the urinary system with the tenth highest incidence in the world,and it is one of the malignant tumors that seriously threaten people’s health.Non-muscle-invasive Bladder Cancer(NMIBC)and muscle-invasive Bladder Cancer(MIBC)are classified according to whether they invade the muscular layer of the Bladder.MIBC refers to bladder cancer at T2 stage and above,with high recurrence and metastasis rate and poor prognosis.The first choice for clinical treatment of MIBC is radical cystectomy,but this operation is highly invasive and requires high tolerance of patients.Furthermore,urine flow diversion after radical cystectomy may affect the quality of life of patients.Therefore,for patients who cannot tolerate or require bladder preservation and refuse radical surgical resection,Comprehensive treatments such as Tansurethral resection of the bladder tumor(TURBT),Partial cystectomy,radiotherapy and chemotherapy are widely used,but the jury is still out on which treatment is more advantageous.With the development of interventional medicine,various interventional techniques in tumor treatment have tended to mature.Interventional therapy for bladder cancer is mainly intra-vascular therapy,including intra-arterial chemotherapy(IAC)and transcatheter arterial chemoembolization(TACE).The tumor is treated by infusion of chemotherapeutic drugs and/or embolization of tumor supplying vessels with embolization agents to achieve high drug concentration locally and block tumor supplying arteries.DEB-TACE are used to embolize tumor blood vessels loaded with chemotherapeutic drugs,which can slowly release chemotherapeutic drugs locally and block tumor blood supply.Compared with general interventional chemoembolization,the efficacy can be further improved.DEB-TACE has achieved remarkable curative effect in the field of interventional therapy of liver cancer.However,interventional therapy for bladder cancer is rarely reported,there is still a lack of large-scale clinical data to confirm the short-term and long-term efficacy and safety of transarterial chemoembolization for bladder cancer.The purpose of this study is to compare the clinical efficacy of DEB-TACE compared with general TACE in the treatment of muscle-invasive bladder cancer,evaluate the safety and effectiveness of DEB-TACE combined with IAC in the treatment of muscle-invasive bladder cancer,and provide a new treatment plan for the treatment of muscle-invasive bladder cancer.Materials and methodsA total of 48 MIBC patients admitted to our center from August 2018 to December 2020 were retrospectively collected,which were intolerant or refused radical bladder resection.General data of patients were recorded and divided into observation group(23 cases)and control group(25 cases)according to the different interventional treatment methods adopted by patients.Transarterial infusion chemotherapy drugs were 50mg/m2 cisplatin(Jiangsu Hengrui Pharmaceutical Company,China)and 1000mg/m2 gemcitabine(1.0g,Hainan Qilu Pharmaceutical Co.LTD).Observation group was loaded with drug-eluting bead CalliSpheres(300-500um,jiangsu hengrui pharmaceutical co.,LTD.)containing 40mg pirubicin(THP,10mg,shenzhen wanle co.,LTD.)as embolic materials,and PVA particles(diameter:350-560um,Hangzhou Alicon Co.,LTD.)were selected as embolization materials for the control group.Bilateral internal iliac artery angiography was performed under DSA and tumor blood supply was observed and recorded.The dose of chemotherapy drugs was allocated reasonably according to the degree of tumor staining,and arterial infusion chemotherapy was performed after catheter crossing the superior gluteal artery by further selective intubation.After that,super-selective intubation was performed with microcatheter to the tumor supplying artery,and drug loaded microspheres were slowly injected under fluoroscopy.After embolization,tumor staining basically disappeared.Intraoperative and postoperative adverse reactions of the two groups were recorded(classified according to the international standard for common adverse reactions(CTCAEv3.0)).Pelvic enhanced CT was performed 2 months after surgery to review the tumor status and evaluate the efficacy according to solid tumor evaluation criteria version 1.1(RECIST1.1).All patients were followed up through outpatient,inpatient review or telephone follow-up,mainly including follow-up treatment plan,and the survival status and time,time and cause of death of the patients were recorded,date of death and cause of death were recorded until the death of patients or the last follow-up date of February 15,2022.ResultsTumor supplying arteries were successfully found in all 48 patients,including bilateral supplying arteries in 41 cases(19 cases in observation group and 22 cases in control group)and unilateral supplying arteries in 7 cases(4 cases in observation group and 3 cases in control group).Before operation,44 patients(21 in the observation group and 23 in the control group)had gross hematuria,which was controlled within 48 hours after operation,the recurrence rate of hematuria in observation group(16.7%)was lower than that in control group(36.4%),and the difference was statistically significant(P<0.05).The clinical evaluation results 2 months after operation showed that no CR cases were observed in both groups.In the observation group,there were 13 cases of PR,8 cases of SD and 2 cases of PD.The postoperative objective response rate(ORR)and disease control rate(DCR)were 57.1%and 86.9%respectively.In the control group,there were 7 cases of PR,11 cases of SD and 7 cases of PD.The postoperative objective response rate(ORR)and disease control rate(DCR)were 28.0%and 72.0%respectively.The postoperative ORR of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).None of the patients had grade III-IV adverse reactions during and after operation.The median overall survival was 12.5 months(95%CI 7.2-17.8 months)in the observation group and 11.6 months(95%CI 7.1-16.0 months)in the control group,and there was no significant difference in the survival curves between the two groups(P>0.05).Multivariate analysis showed that T stage(HR=2.629,95%CI:1.090-6.344,P=0.002)and pathological grade(HR=2.956,95%CI:1.325-6.591,P=0.008)were the main risk factors for survivalConclusion①Transarterial infusion chemotherapy combined with drug-loaded microsphere embolization is a minimally invasive,safe and effective clinical treatment for muscle-infiltrating bladder cancer,which is worthy of further clinical application②For patients with muscular infiltrating bladder cancer complicated with refractory macroscopic hematuria,transarterial infusion chemotherapy combined with drug-loaded microsphere embolization therapy can effectively control the progression and recurrence of hematuria in the near and medium term... |
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