目的：系统评价表柔比星(EPI)和丝裂霉素(MMC)对非肌层浸润性膀胱癌(NMIBC)患者灌注化疗后的疗效与不良反应。方法：计算机检索CNKI、万方、VIP、SinoMed、PubMed、Embase、The Cochrance Library、Web of science中自建库至2023年1月期间关于表柔比星和丝裂霉素治疗NMIBC的中英文随机对照试验。采用RevMan 5.3软件对EPI组与MMC组患者的术后肿瘤复发率、总不良反应发生率、膀胱刺激征发生率、肝肾功能损害、血尿进行meta分析。结果：符合纳排标准16项研究,共1244例患者,其中EPI组626例,MMC组618例。Meta分析结果:EPI组患者术后肿瘤复发率[OR=0.55, 95%CI(0.41, 0.73), P＜0.01]、总不良反应发生率[OR=0.56, 95%CI(0.38, 0.82), P=0.003]、膀胱刺激征发生率[OR=0.54, 95%CI(0.37,0.77), P=0.0007]、血尿发生率[OR=0.53, 95%CI(0.33,0.85), P=0.009]、肝肾功能损害发生率[OR=0.26, 95%CI(0.10, 0.69), P=0.007]均显著低于MMC组(P＜0.05)。结论：EPI在治疗效果和总不良反应发生率方面优于MMC,膀胱癌术后推荐使用EPI膀胱灌注预防肿瘤复发,改善患者的预后。
Abstract
Objective: To systematically evaluate the efficacy and adverse reactions of epirubicin (EPI) and mitomycin (MMC) in patients with non-muscle invasive bladder cancer (NMIBC) after perfusion chemotherapy. Methods: CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, The Cochrance Library and Web of science were searched for Chinese and English randomized controlled trials of epirubicin and mitomycin in the treatment of NMIBC from the establishment of the database to January 2023. RevMan 5.3 software was used to perform a meta-analysis of postoperative tumor recurrence rate, total incidence of adverse reactions, incidence of bladder irritation, liver and kidney function damage, and hematuria in the EPI group and the MMC group. Results: There were 16 studies that met the inclusion and exclusion criteria, with a total of 1244 patients, while 626 patients in the EPI group and 618 patients in the MMC group. The results of meta-analysis showed that the postoperative tumor recurrence rate [OR=0.55,95%CI(0.41, 0.73), P＜0.01], the incidence of total adverse reactions [OR=0.56,95%CI(0.38, 0.82), P=0.003], the incidence of bladder irritation [OR=0.54, 95%CI(0.37, 0.77), P=0.0007], the incidence of hematuria [OR=0.53,95%CI(0.33, 0.85), P=0.009], and the incidence of liver and kidney dysfunction [OR=0.26, 95%CI(0.10, 0.69), P=0.007] in the EPI group were significantly lower than those in the MMC group (P＜0.05). Conclusion: EPI is superior to MMC in terms of therapeutic effect and total incidence of adverse reactions. EPI bladder perfusion is recommended to prevent tumor recurrence and improve the prognosis of patients after bladder cancer surgery.
关键词
膀胱癌 /
表柔比星 /
丝裂霉素 /
膀胱灌注 /
荟萃分析
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Key words
Bladder cancer /
Epirubicin /
Mitomycin /
Bladder instillation /
Meta-analysis
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参考文献
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脚注
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基金
浙江省医药卫生科技计划项目(2023RC199);内蒙古自然科学基金项目(2021MS08009);内蒙古自治区高等学校青年科技英才支持计划(NJYT-20-B22)
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