吉西他滨联合卡铂治疗浸润性膀胱癌手术患者临床研究

Clinical Research of Gemcitabine Combined with Carboplatin in Treating Patients with Invasive Bladder Cancer Surgery

目的观察吉西他滨联合卡铂在浸润性膀胱癌手术前化学治疗（简称化疗）中的临床疗效。方法将100例浸润性膀胱癌患者按随机数字表法分为研究组和对照组,各50例。研究组患者采用吉西他滨＋卡铂方案,对照组患者采用吉西他滨＋顺铂方案,21 d为1个化疗周期。两组患者均在完成2～3个周期后对化疗的近期疗效及不良反应进行评价;化疗后均采用保留膀胱的手术治疗,比较两组患者的远期预后效果。结果研究组的缓解率为79.59%,总有效率为95.92%,与对照组的68.75%和91.67%相比,差异无统计学意义（P〉0.05）;化疗后两组患者的肿瘤最大径均较化疗前显著缩小（P〈0.05）;研究组的消化道反应、肝功能损伤、肾功能损伤、皮疹及血管炎发生率显著低于对照组（P〈0.05）;研究组的1年,2年,3年生存率分别为71.43%,48.98%,34.69%,高于对照组的68.75%,41.67%,25.00%,但差异无统计学意义（P〉0.05）;研究组患者的3年中位生存期为24.5个月,高于对照组的23.7个月,但差异无统计学意义（χ～2=0.846,P〉0.05）。结论术前应用吉西他滨联合卡铂在浸润性膀胱癌手术前化疗中的效果与吉西他滨联合顺铂相当,但前者毒副反应发生率更低,尤其是肾功能损害发生率更低。

Objective To observe the clinical efficacy of gemcitabine and carboplatin used in the chemotherapy before the invasive bladder cancer surgery. Methods 100 patients with invasive bladder cancer patients who met the inclusion criteria were randomly divided into the study group and the control group,50 cases in each group. The study group received gemcitabine ＋ carboplatin,the control group received gemcitabine ＋ cisplatin,21 d was 1 course of treatment. The recent adverse reactions were evaluated in the two groups after completing 2- 3 cycles of chemotherapy; after chemotherapy,all patients were treated with surgery that retained the bladder,and the long-term prognosis were observed and compared between the two groups. Results The response rate of the study group was 79. 59%,the total effective rate was 95. 92%,which had no statistically significant difference with 68. 75%,91. 67% of the control group（ P〈0. 05）;the tumor sizes of the two groups after chemotherapy were significantly reduced compared with before chemotherapy（ P〈0. 05）; the gastrointestinal reactions,liver damage,kidney damage,skin rashes and vasculitis of the study group were significantly lower than those of the control group（ P〈0. 05）; the 1,2,3- year survival rates of the study group were 71. 43%,48. 98%,34. 69%,which were higher than 68. 75%,41. 67%,25. 00% of the control group but without statistically significant difference（ P〈0. 05）; the 3- year median survival time of the study group was 24. 5 months,which was longer than 23. 7 months of the control group but without statistically significant difference（ χ～2 = 0. 846,P〈0. 05）. Conclusion Preoperative gemcitabine combined with carboplatin in chemotherapy before invasive bladder cancer surgery has equivalent effect with gemcitabine combined with cisplatin,but the former combination has fewer incidence of adverse reactions,especially lower incidence of renal damage.