Abstract:Objective To compare the clinical effect of the repeat transurethral resection(re-TUR) combined with intravesical instillation chemotherapy of gemcitabine versus radical resection of bladder cancer in treatment of muscle-invasive bladder cancer. Methods The clinical data of 204 patients with muscle-invasive bladder cancer treated in the Department of Urinary Surgery of the Fourth People's Hospital of Shanghai from March 2011 to March 2015 were analyzed retrospectively, in whom there were 85 patients treated with radical resection of bladder cancer (operation group) and 119 patients treated with re-TUR combined with intravesical instillation chemotherapy of gemcitabine (combined group). The curative effect, the incidence of complications and adverse reactions were compared between two groups. Changes in urine tumor marker levels were recorded before and after treatment; the tumor recurrence rates in 2 years after operation were observed; changes in the scores of Generic Quality of Life Inventory-74(GQOLI-74) and the Karnofsky Performance Scale (KPS) at different time points were compared between two groups. Results There was no significant difference in the total remission rate between two groups (48.74% vs 51.76%, P>0.05). The incidences of complication of respiratory tract infection (0.84% vs 11.76%) and incision infection (0 vs 11.76%) in combined group were significantly lower than those in operation group(all P<0.05). The incidence of gastrointestinal response in combined group was slightly higher than that in operation group, and the incidence of other adverse reactions was similar in two groups (P>0.05). There was no significant difference in recurrence rate at 24 months after operation between two groups (16.81% vs 16.47%, P>0.05). Before operation, there were no significant differences in levels of urine tumor markers between two groups(P>0.05). At 3 months after operation, the levels of nuclear matrix protein 22(NMP22), cytokeratin 19 soluble fragment 21-1(CYFR21-1) and bladder tumor antigen(BTA) significantly decreased in both groups compared with preoperative(all P<0.05), but there were no statistical differences between two groups(all P>0.05). The scores of GQOLI-74 and KPS in combined group were statistically higher than those in operation group at different time points after operation(all P<0.01). Conclusion The re-TUR combined with intravesical instillation of gemcitabine chemotherapy has a high total remission rate, low recurrence rate and few complication, which can better improve the quality of life and physical condition of patients with muscle-invasive bladder cancer.