• 1. 四川大學(xué)華西醫(yī)院泌尿外科,成都,6100412. 青島港口醫(yī)院泌尿外科,青島,2660113. 四川大學(xué)華西醫(yī)學(xué)中心臨床流行病學(xué)教研室,成都,6100414. 牡丹江市第二人民醫(yī)院泌尿外科,牡丹江,157000;

目的 　通過比較經(jīng)尿道膀胱腫瘤切除術(shù)(transurethral resection of the bladder tumor,TURB-t)加術(shù)后膀胱灌注阿霉素不同衍生物與只行TURB-t術(shù)后的腫瘤復(fù)發(fā)率,評價膀胱灌注阿霉素是否可以有效預(yù)防表淺性膀胱癌術(shù)后復(fù)發(fā).
方法 　按Cochrane協(xié)作網(wǎng)工作手冊的要求,制定相應(yīng)的納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)及檢索策略.在美國醫(yī)學(xué)索引、荷蘭醫(yī)學(xué)文摘、中國生物醫(yī)學(xué)文摘及Cochrane圖書館內(nèi)進(jìn)行相關(guān)的隨機(jī)對照試驗檢索.Jadad質(zhì)量計分法評價文獻(xiàn)的質(zhì)量,資料用統(tǒng)一的表格進(jìn)行提取,采用Revman軟件進(jìn)行數(shù)據(jù)處理和分析.
結(jié)果 　共檢索到相關(guān)文獻(xiàn)33篇,符合納入標(biāo)準(zhǔn)的有18篇,排除15篇.Meta-分析表明,用吡喃阿霉素、表阿霉素及阿霉素進(jìn)行術(shù)后膀胱灌注均可以降低表淺性膀胱癌術(shù)后1年及2年復(fù)發(fā)率.
結(jié)論 　TUPB-t術(shù)后膀胱灌注吡喃阿霉素、表阿霉素及阿霉素可以降低表淺性膀胱癌術(shù)后1年及2年復(fù)發(fā)率.但膀胱灌注的劑量、保留時間、療程等因素對預(yù)后的影響尚待進(jìn)一步研究.

引用本文： 魏強(qiáng),彭國輝,張劍,韓平,劉關(guān)鍵,梁化東,張躍利. 阿霉素不同衍生物膀胱灌注對預(yù)防表淺性膀胱癌術(shù)后復(fù)發(fā)效果的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2004, 04(2): 104-113. doi: 復(fù)制

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2. ［2］Fleischmann J, Goldberg G. Management of superficial transitional cell carcinoma of the bladder[J ]. Semin Urol, 1993 ;11(4) :193-204.
3. ［3］Fitzpatrick JM. Superficial bladder carcinoma. Factors affecting the natural history[J]. World J Urol, 1993;11 (3) :142-147.
4. ［4］Jadad AR., Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of raildomized clinical trials: IS blinding necessary [ J ] ?Control Clin Trials, 1996; 17 (1): 1-12.
5. ［5］Kjacrgard LL, Villumsen J, Gluud C. Quality of randomized cliuical trials affects estimates of intervention efficacy (abstract). In: VII Cochrane Colloquium [ C ], Rome, 1999:57.
6. ［6］Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyes[J]. Lancet, 1998;352(9128): 609-613.
7. ［7］Clarke M, Oxman AD, editors. Cochrane Reviewers Haudbook 4. 0 [ updated July 1999 ]; Section 6. In: The Cochrane Library [ database on CD/ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issuel.
8. ［8］Schulz KF, Chahmers I, Hayes R, Altman D. Empirical evidence of bias[J ]. JAMA, 1995 ;273 (5) :408-412.
9. ［9］Kurth KH, Schroder FH, Tunn U, Ay R, Pavone-Macaluso M, Debruyne F, de Pauw M, Dalesio O, ten Kate F.Adjuvant chemotherapy of superficial transitional cell bladder carcinoma: preliminary results of a European organization for research on treatment of cancer. Randomized trial comparing doxorubicin hydrochloride, ethoglucid and transurethral resection alone [ J ]. J Urol, 1984; 132 (2) :258-262.
10. ［10］Zincke H, Utz DC, Taylor WF, Myers RP, Leary FJ. Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind,controlled trial [ J ]. J Urol, 1983; 129 (3): 505-509.
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13. ［13］van der Meijden AP, Kurth KH, Oosterlinck W, Debruyne FM. Intravesical therapy with adriamycin and 4-epirubicin for superficial bladder cancer: the experience of the EORTC GU Group [ J ]. Cancer Chemother Pharmacol, 1992; 30(Suppl): S95-98.
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15. ［15］Maekawa S, Suzuki H, Ohkubo K, et al. Continuous intravesical instillation of epirubicin immediately after transuretbral resection of superficial bladder cancer: a prospective controlled study[J ]. Hinyokika Kiyo, 2000 ;46 (5) :301-306.
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17. ［17］Anonymous. Intravesical doxorubicin for the prophylaxis of superficial bladder tumors. A multicenter study[J ]. Blinst Italian Cooperative Group. Cancer, 1984; 54 (4): 756-761.
18. ［18］Huncharek M, Mc Garry R, Kupelnick B. Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: results of a metaanalysis[J]. Anticancer Res, 2001 ;21 (1B) :765-769.
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20. ［20］HiraoY, OkajimaE, OharaS, OzonoS, HiramatsuT,Yoshida K, Yamada K, Aoyama H, Hashimoto M, Watanabe S. Prophylactic treatment for superficial bladder cancer following transurethral resection [ J ]. Cancer Chemother Pharmacol, 1987; 20 (Suppl) :S85-90.
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26. ［26］Ali-el-Dein B, Nabeeh A, El-Baz M, Shamaa S, Ashamallah A. Siugle-dose versus multiple instillations of epimbicin as prophylaxis for recurrence after transurethral resection of pTa and PT1 transitional-cell bladder tumours: a prospective,raudomized controlled study[J]. Br J Urol, 1997; 79 (5):731-735.
27. ［27］Hirao Y, Ozono S, Momose H, Okajima E, Hiramatsu T,Yoshida K, Fukushima S, Ohashi Y. Prospective randomized study of prophylaxis of superficial bladder cancer with epirubicin: the role of a central pathology laboratory[J]. Nara Uro-oncology Research Group. (NUORG). Cancer Chemother Pharmacol, 1994; 35 (Suppl): S36-40.
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  1. 1. ［1］Lurn BL, Tort. Adjuvant intravesical pharmacology for superficial bladder cancer [ J ]. Journal of the National Cancer Institate, 1991 ;83(10) :682-694.
  2. 2. ［2］Fleischmann J, Goldberg G. Management of superficial transitional cell carcinoma of the bladder[J ]. Semin Urol, 1993 ;11(4) :193-204.
  3. 3. ［3］Fitzpatrick JM. Superficial bladder carcinoma. Factors affecting the natural history[J]. World J Urol, 1993;11 (3) :142-147.
  4. 4. ［4］Jadad AR., Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of raildomized clinical trials: IS blinding necessary [ J ] ?Control Clin Trials, 1996; 17 (1): 1-12.
  5. 5. ［5］Kjacrgard LL, Villumsen J, Gluud C. Quality of randomized cliuical trials affects estimates of intervention efficacy (abstract). In: VII Cochrane Colloquium [ C ], Rome, 1999:57.
  6. 6. ［6］Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyes[J]. Lancet, 1998;352(9128): 609-613.
  7. 7. ［7］Clarke M, Oxman AD, editors. Cochrane Reviewers Haudbook 4. 0 [ updated July 1999 ]; Section 6. In: The Cochrane Library [ database on CD/ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issuel.
  8. 8. ［8］Schulz KF, Chahmers I, Hayes R, Altman D. Empirical evidence of bias[J ]. JAMA, 1995 ;273 (5) :408-412.
  9. 9. ［9］Kurth KH, Schroder FH, Tunn U, Ay R, Pavone-Macaluso M, Debruyne F, de Pauw M, Dalesio O, ten Kate F.Adjuvant chemotherapy of superficial transitional cell bladder carcinoma: preliminary results of a European organization for research on treatment of cancer. Randomized trial comparing doxorubicin hydrochloride, ethoglucid and transurethral resection alone [ J ]. J Urol, 1984; 132 (2) :258-262.
  10. 10. ［10］Zincke H, Utz DC, Taylor WF, Myers RP, Leary FJ. Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind,controlled trial [ J ]. J Urol, 1983; 129 (3): 505-509.
  11. 11. ［11］Niijima T, Koiso K, Akaza H. Randomized clinical trial on chemoprophylaxis of recurrence in cases of superficial bladder cancer [ J ]. Cancer Chemother Pharmacol, 1983; 11 (Suppl):S79-82.
  12. 12. ［12］Pavone Macaluso M, Tfipi M, Ingargiola GB. Cooperative studies of chemoprophylaxis after transurethral resection of bladder tumors [J ]. Cancer Chemother Pharmacol, 1983; 11(Suppl): S16-21.
  13. 13. ［13］van der Meijden AP, Kurth KH, Oosterlinck W, Debruyne FM. Intravesical therapy with adriamycin and 4-epirubicin for superficial bladder cancer: the experience of the EORTC GU Group [ J ]. Cancer Chemother Pharmacol, 1992; 30(Suppl): S95-98.
  14. 14. ［14］Akaza H, KoisoK, KotakeT, Matsumura Y, Isaka S,Machida T, Obata K, Ohashi Y, Ohe H, Ohi Y, et al.Long-term results ofintravesical chemoprophylaxis of superficial bladder cancer: experience of the Japanese Urological Cancer Research Group for Adriamycin [ J ]. Cancer Chemother Pharmacol, 1992 ;30 (Suppl) :S15-20.
  15. 15. ［15］Maekawa S, Suzuki H, Ohkubo K, et al. Continuous intravesical instillation of epirubicin immediately after transuretbral resection of superficial bladder cancer: a prospective controlled study[J ]. Hinyokika Kiyo, 2000 ;46 (5) :301-306.
  16. 16. ［16］Isaka S, Okano T, Shimazaki J. Prophylaxis of superficial bladder cancer with instillation of adriamycin or mitomycin C[J]. Cancer Chemother Pharmacol, 1987 ;20 (Suppl) :S77-80.
  17. 17. ［17］Anonymous. Intravesical doxorubicin for the prophylaxis of superficial bladder tumors. A multicenter study[J ]. Blinst Italian Cooperative Group. Cancer, 1984; 54 (4): 756-761.
  18. 18. ［18］Huncharek M, Mc Garry R, Kupelnick B. Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: results of a metaanalysis[J]. Anticancer Res, 2001 ;21 (1B) :765-769.
  19. 19. ［19］Hinotsu S, Akaza H, Ohashi Y, Kotake T. lntravesical chemotherapy for maximum prophylaxis of new early phase superficial bladder carcinoma treated by transurethral resection:a combined analysis of trials by the Japanese Urological Cancer Research Group using smoothed hazard function[J]. Cancer,1999;86(9) :1818-1826.
  20. 20. ［20］HiraoY, OkajimaE, OharaS, OzonoS, HiramatsuT,Yoshida K, Yamada K, Aoyama H, Hashimoto M, Watanabe S. Prophylactic treatment for superficial bladder cancer following transurethral resection [ J ]. Cancer Chemother Pharmacol, 1987; 20 (Suppl) :S85-90.
  21. 21. ［21］Togashi M, Shinohara N, Toyota K, Koyanagi T, Maru A,Fujieda J, Kawakura K, Nishida T, Ohashi N. Prophylactic chemotherapy for primary and recurrent superficial bladder cancer: preliminary results [J ]. The Hokkaido University Bladder Cancer Collaborating Group. Cancer Chemother Phannacol, 1992 ;30 (Suppl): S21-25.
  22. 22. ［22］Tsushima T, Matsumura Y, Ozaki Y, Yoshimoto J, Ohmori H. Prophylactic intravesical instillation therapy with adriamycin and mitomycin C in patients with superficial bladder cancer[J]. Cancer Chemother Pharmacol, 1987 ;20 (Suppl): S72-76.
  23. 23. ［23］Rubben H, Lutzeyer W, Fischer N, Deutz F, Lagrange W,Giani G. Natural history and treatment of low and high risk superficial bladder tumors[J ]. J Urol, 1988; 139 (2) :283-285.
  24. 24. ［24］Akaza H, Isaka S, Koiso K, Kotake T, Machida T, Maru A,Matsumura Y, Niijima T, Obata K, Ohe H, et al.Comparative analysis of short-term and long-term prophylactic intravesical chemotherapy of superficial bladder cancer.Prospective, randomized, controlled studies of the Japauese Urological Cancer Research Group [J ]. Cancer Chemother Pharmacol, 1987 ;20 (Suppl): S91-96.
  25. 25. ［25］Ali-el-Dein B, EI-Baz M, Aly AN, Shamaa S, Ashamallah A.Intravesical epirubicin versus doxorubicin for superficial bladder tumors (stages pTa and pT1): a randomized prospective study[J]. J Urol, 1997; 158(1): 68-74.
  26. 26. ［26］Ali-el-Dein B, Nabeeh A, El-Baz M, Shamaa S, Ashamallah A. Siugle-dose versus multiple instillations of epimbicin as prophylaxis for recurrence after transurethral resection of pTa and PT1 transitional-cell bladder tumours: a prospective,raudomized controlled study[J]. Br J Urol, 1997; 79 (5):731-735.
  27. 27. ［27］Hirao Y, Ozono S, Momose H, Okajima E, Hiramatsu T,Yoshida K, Fukushima S, Ohashi Y. Prospective randomized study of prophylaxis of superficial bladder cancer with epirubicin: the role of a central pathology laboratory[J]. Nara Uro-oncology Research Group. (NUORG). Cancer Chemother Pharmacol, 1994; 35 (Suppl): S36-40.
  28. 28. ［28］Kubota Y, Noguchi S, Shuin T, Moriyama M, Hosaka M,Satomi Y, Furuhata A, Kondo I, Sakuramoto T, Yao M, et al. Preoperative doxorubicin instillation in recurrent superficial bladder cancer[J ]. Cancer Chemother Pharmacol, 1987; 20(Suppl): S56-59.
  29. 29. ［29］Kurth K, Tunn U, Ay R, Schroder FH, Pavone-Macaluso M, Debruyne F, ten Kate F, de Pauw M, Sylvester R.Adjuvant chemotherapy for superficial transitional cell bladder carcinoma: long-term results of a European Organization for Research and Treatment of Cancer randomized trial comparing doxorubicin, ethoglucid and transurethral resection alone[J ].J Urol, 1997; 158(2): 378-384.
  30. 30. ［30］Matsumura Y, Akaza H, Isaka S, Kagawa S, Koiso K, Kotake T, Machida T, Niijima T, Obata K, Ohashi Y, et al. The 4th study of prophylactic intravesical chemotherapy with adriamycin in the treatment of superficial bladder cancer: the experieuce of the Japanese Urological Cancer Research Group for Adriamycin [ J ]. Cancer Chemother Pharmacol, 1992; 30(Suppl): S10-14.
  31. 31. ［31］Melekos MD, Dauaher H, Fokaefs E, Barbalias G. Intravesical instillations of 4-epi-doxorubicin (epirubicin) in the prophylactic treatment of superficial bladder cancer: results of a controlled prospective study [ J ]. J Urol, 1992; 147 (2): 371-375.
  32. 32. ［32］Melekos MD, Chionis HS, Paranychianakis GS, Dauber HH.Intravesical 4-epi-doxorubicin (epirubicin) versus bacillus Calmette-Guerin. A controlled prospective study on the prophylaxis of superficial bladder cancer[J]. Cancer, 1993; 72(5): 1749-1755.
  33. 33. ［33］Miki T, Nonomura N, Kojima Y, Okuyama A, Nakano E,Kiyohara H, Fujioka H, Koide T, Wakatsuki A, Kuroda H,Sugao H, Seguti T, Takeyama M, Yamaguchi S. A randomized study on intravesical pirarubicin (THP)chemoprophylaxis of recurrence after transurethral resection of superficial bladder cancer [J]. Hinyokika Kiyo, 1997; 43(12): 907-912.
  34. 34. ［34］Nonomura N, Nishimura K, Okuyama A, et al. Prophylactic effect of pirarubiciri (THP) on postoperative recurrence of superficial bladder cancer in terms of intravesical retention time[J]. Hinyokika Kiyo, 2001; 47(5): 315-319.
  35. 35. ［35］Obata K, Ohashi Y, Akaza H, Isaka S, Kagawa S, Koiso K,Kotake T, Machida T, Matsumura Y, Niijima T, et al.Prophylactic chemotherapy with intravesical instillation of adriamycin and oral administration of 5-fluorouracil after surgery for superficial bladder cancer [ J ]. The Japanese Urological Cancer Research Group for Adriamycin. Cancer Chemother Pharmacol, 1994; 35 (Suppl): S88-92.
  36. 36. ［36］Okamura K, Murase T, Obata KA. Randomized trial of early intravesical instillation of epirubicin in superficial bladder cancer[J]. Cancer Chemother Pharmacol, 1994; (Suppl): S31-35.
  37. 37. ［37］Okamura K, Oho Y, Kinukawa T, Matsuura O, Yamada S,Ando T, Fukatsu T, OhnoY, Ohshima S; Nagoya University Urological Oncology Group. Randomized study of single early instillation of (2" R)-4 ’-O-tetrahydropyranyl-doxorubicin for a single superficial bladder carcinoma[J ]. Cancer, 2002; 94(9): 2363-2368.
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