Cochrane Database Syst Rev:蓝光 vs 白光TURBT在非肌肉浸润性膀胱癌经尿道切除中的应用

2021-12-06 Nebula MedSci原创

与白光TURBT相比,采用蓝光强化的TURBT治疗非肌肉浸润性膀胱癌或可降低疾病复发和进展风险

复发和进展仍然是非肌肉浸润性膀胱癌(NMIBC)治疗的主要挑战。蓝光强化的经尿道膀胱癌切除术 (TURBT) 是一种改善膀胱癌分期和实现完整切除NMIBC的方法

本研究旨在评估蓝光强化的TURBT与基于白光的TURBT相比治疗NMIBC的效果。

研究人员全面检索了多个医学文献数据库(包括Cochrane Library、MEDLINE和Embase)和临床试验注册处(ClinicalTrials.gov和the World Health Organization International Clinical Trials Registry Platform)2021年3月之前收录的研究,纳入了对比采用蓝光和白光TURBT的随机对照试验,且要求受试患者是原发性或复发性膀胱尿路上皮癌。主要终点是疾病复发的时间、疾病进展的时间和严重的手术并发症。次要终点是膀胱癌死亡时间、任何副反应和非严重的并发症。

复发风险对比

共纳入了16项随机对照试验,涵盖4325位患者。蓝光TURBT可降低膀胱癌随时间推移的复发风险(风险比[HR] 0.66)。与白光TURBT治疗相关,蓝光TURBT治疗可使低、中、高风险NMIBC患者的复发率分别减少46例、109例和147例/1000人。

进展风险对比

蓝光TURBT还可能降低疾病进展的风险(HR 0.65)。与白光TURBT相比,蓝光TURBT可使低、中、高风险NMIBC患者的进展率分别减少1例、17例和56例/1000人。

并发症风险对比

此外,蓝光TURBT对严重手术并发症的影响很小或甚至没有影响(风险比[RR] 0.54)。蓝光TURBT治疗的手术并发症比白光TURBT治疗每1000人少10例。

随着时间的推移,蓝光TURBT可能对膀胱癌死亡风险影响甚微或没有影响(膀胱癌死亡率;蓝光 vs 白光:10 vs 22例/1000人)。目前研究人员还不确定蓝光TURBT对任何级别的副反应的影响。

综上所述,与白光TURBT相比,采用蓝光强化的TURBT治疗非肌肉浸润性膀胱癌或可降低疾病复发和进展风险,降低效果因基线风险高低而异。而且,蓝光对严重手术并发症的影响微乎其微甚至几近于零。

原始出处:

Maisch Philipp,Koziarz Alex,Vajgrt Jon et al. Blue versus white light for transurethral resection of non-muscle invasive bladder cancer.[J] .Cochrane Database Syst Rev, 2021, 12: CD013776.

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    2022-02-23 lifestar
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    2021-12-08 bbjsj_1981
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    2021-12-07 查查佳佳

    上海市女医师协会从2021年9月启动

    0

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    2021-12-06 ms5000000518166734

    已读已读已读已读已读已读已读已读已读已读已读已读谢已读

    0

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