吉西他滨＋顺铂联合化疗在保留膀胱治疗肌层浸润性膀胱癌的临床疗效评价

Clinical evaluation of the effect of bladder - sparing therapy combined with gemcitabine and cisplatin for muscle invasive bladder cancer

目的探讨保留膀胱手术结合吉西他滨＋顺铂化疗在肌层浸润性膀胱癌（MIBC）治疗中的临床疗效和不良反应。方法收集本院2008年1月至2010年12月30例经尿道膀胱肿瘤切电（TURBT）术后病检明确MIBC患者，其中肿瘤分期为：T2aNOM0-T3aNOM0，肿瘤为单发或多发，肿瘤最大直径小于4cm，行吉西他滨＋顺铂（GC方案）化疗，吉西他滨1000mg／m^2于第1、8天静脉滴注，顺铂30mg／m^2静脉滴注，于第2—4天，每21d重复，均行4～6疗程化疗。结果30例患者均获得随访，平均36个月，其中20例患者无复发及转移，10例患者复发，2例化疗2周期后复发，再次行TURBT后化疗4周期，随访未复发；4例患者给予全膀胱切除术，4例患者给予TURBT后行放疗，其中2例患者因肿瘤复发死亡，1例患者带瘤生存，1例患者未复发，所有患者无严重化疗副反应，均可耐受，无化疗死亡病例。结论TURBT术后确诊的MIBC患者采用吉西他滨＋顺铂化疗能明显的提高疗效，有效地减少肿瘤的复发，相对于膀胱全切，提高了患者的生活质量，患者易于接受，为不能耐受全膀胱切除或不愿行全膀胱切除的膀胱癌患者提供了新的治疗模式。

Objectives To investigate clinical efficacy and adverse reactions of bladder - sparing therapy combined with emcitabine and cisplatin （GC） for muscle invasive bladder cancer （MIBC） . Methods 30 patients with MIBC underwent transurethral resection of the bladder tumor（TURBT） in our hospital from January 2008 to December 2010 were collected. The tumor staging was T2aNOM0 - T3aNOM0 , and maximum tumor diameter was less than 4cm, single or multiple. The GC chemotherapy was given by gemcitabine （ 1000mg/m^2） on clay 1 and day 8, cisplatin （30mg/m^2 ） on day 2 and day 4. The regimen was repeated every 21 days, Results 30 patients were followed up for average 36 months, 20 patients remained recurrence and metastasis free, 10 cases recurred, 2 cases recurred after 2 cycles of chemotherapy, and again underwent TURBT after four cycles of chemotherapy, without recurrence during follow- up. 4 patients received radical cystectomy,4 patients received radiotherapy after TURBT, and 2 patients died of tumor recurrence. No patients with serious side effects of chemotherapy were included and well tolerable. Conclusions Bladder-sparing therapy combined with gemcitabine and cisplatin in treatment of patients with muscle invasive bladder cancer who underwent TURBT, which would significantly improve the curative effect and reduce recurrence of tumor,compared with total cystectomy,which could be easily accepted by the patients,improve the quality of life of patients and provide a new way for the patients who unable or unwilling to underwent radical cystectomy.