吉西他滨联合顺铂新辅助化疗对膀胱癌根治术患者预后的影响

Effect of Neoadjuvant Chemotherapy with Gemcitabine and Cisplatin on the Prognosis of Bladder Cancer

目的探讨吉西他滨联合顺铂新辅助化疗对膀胱癌根治术患者预后的影响。方法选择肌层浸润性膀胱癌患者82例。按照化疗方案的不同分为MVAC组和GC组。MVAC方案:甲氨蝶呤30 mg/m^2和长春花碱3 mg/m^2,静脉滴注,第2、15、22天;阿霉素30 mg/m^2和顺铂70 mg/m^2,静脉滴注,第2天;22天为1个化疗周期。GC方案:吉西他滨1000 mg/m^2,静脉滴注,第1、8天;顺铂70 mg/m^2,静脉滴注;21天为1个化疗周期。观察两组患者治疗后的生存情况和复发情况及不良反应发生情况。结果 GC组肿瘤降期率为62.5%;MVAC组肿瘤降期率为32.4%。GC组患者肿瘤降期率显著高于MVAC组(χ~2=18.602,P=0.000)。GC组死亡率为33.3%,MVAC组死亡率为44.1%。GC组中位生存时间为78.7个,MVAC组中位生存时间为60.2个月,2组比较差异有统计学意义(χ~2=3.953,P=20.047)。GC组复发率为50.0%,MVAC组复发率为52.9%,2组无复发生存时间比较差异有统计学意义(χ~2=4.981,P=20.029)。2组患者不良反应比较差异无统计学意义(P>0.05)。结论 GC方案新辅助化疗可以使肿瘤降期,明显改善患者的预后,延长患者的总生存期和无复发生存期。

Objective To investigate the effect of neoadjuvant chemotherapy with gemcitabine and cisplatin on the prog- nosis of patients with bladder cancer. Methods 82 cases of muscle invasive bladder cancer were selected. According to the dif- ferent points of chemotherapy, they were divided into MVAC group and GC group. MYAC regimen：methotrexate 30mg/m2 and vin- blastine 3mg/m2 ,intravenous infusion, 2nd, 15th, 22th day; Adriamycin 30mg/m2 and cisplatin 70mg/m2, intravenous infusion, 2nd day ;22 days for a chemotherapy cycle. GC regimen ： Gemcitabine 1000mg/m2, intravenous infusion, first, 8th days ; cisplatin 70mg/m2,intravenous infusion;21 days for a chemotherapy cycle. Survival, recurrence and adverse reactions of the 2 groups were observed. Results The tumor reduction stage rate of GC group was 62.5%, and 32.4% in group MVAC. Tumor downstaging rate in GC group was significantly higher than that of MVAC group （x2 = 18,602,P =20. 000）. Mortality rate was 33.3% in group GC and 44.1% in group MVAC. The median survival time of GC group was 78.7 months, and 60.2 months in MVAC group, the difference between the 2 groups had statistical significance （ x2 = 3. 953, P = 0. 047 ）. The recurrence rate of GC group was 50.0% , and 52.9 % of MVAC group, there was no significantly difference in survival time （ x2 = 4.981, P = 0.029 ）. There was no significant difference in adverse reactions between the 2 groups （P 〉 0.05 ）. Conclusion GC neoadjuvant chemotherapy can re- duce tumor stage, significantly improve the prognosis of patients, and prolong the overall survival and relapse free survival.