肝动脉介入栓塞化疗联合系统性化疗对尿路上皮癌肝转移患者的疗效及安全性

Efficacy and safety of transcatheter arterial chemoembolization combined with systemic chemotherapy in urothelial carcinoma patients with liver metastasis

目的:探讨尿路上皮癌肝转移患者的临床治疗方法及其安全性。方法:回顾性分析2006年12月—2016年12月在北京大学肿瘤医院肾癌黑色素瘤内科接受治疗的42例尿路上皮癌肝转移患者的临床资料。42例患者分为3组,分别接受紫杉醇+吉西他滨、紫杉醇+吉西他滨+顺铂,或紫杉醇+吉西他滨+肝动脉介入栓塞化疗(transcatheter arterial chemoembolization,TACE)。持续用药至肿瘤进展或出现不可耐受的不良反应,然后分析各方案治疗组患者的疗效及治疗相关性不良反应。结果:42例患者的中位疾病无进展生存(progression-free survival,PFS)时间为(2.0±0.7)[95%可信区间(condence interval,CI):0.6~3.4]个月,中位总生存(overall survival,OS)时间为(6.1±1.7)(95%CI:4.1~9.9)个月。行系统性化疗联合TACE组的12例患者的中位PFS时间为(7.1±0.7)(95%CI:5.7~8.5)个月,中位OS时间为(14.1±3.0)(95%CI:8.3~19.9)个月,与单纯化疗组相比,差异均有统计学意义(P值均<0.01)。联合治疗组患者耐受性尚可,常见的不良反应为1~2级消化系统反应、上腹部疼痛和白细胞减少。结论:TACE联合系统性化疗是治疗尿路上皮癌肝转移患者的一种有效方案,安全性良好。

Objective： To investigate the efficacious and safe therapy for urothelial carcinoma patients with liver metastasis. Methods： A total of 42 urothelial carcinoma patients with liver metastasis from December 2006 to December 2016 at Department of Renal Carcinoma and Melanoma in Beijing Cancer Hospital were included in this retrospective study. All patients were divided into three groups, and treated with paclitaxel plus gemcitabine, paclitaxel plus gemcitabine and cisplatin, or paclitaxel plus gemcitabine combined with transcatheter arterial chemoembolization （TACE）, respectively. The treatment continued until disease progression or intolerable adverse reactions occurred. The efficacy and treatment-related adverse reactions in different groups were analyzed specifically. Results： For the 42 patients, the median progression-free survival time （PFS） was 2.0±0.7 months [95% confidence interval （C/）： 0.6-3.4], and the median overall survival time （OS） was 6.1 ±1.7 months （95% CI： 4.1-9.9）. For the 12 patients receiving TACE combined with systemic chemotherapy, the median PFS was 7.1 ±0.7 months （95% CI： 5.7-8.5）, the median OS was 14.1 ±3.0 months （95% CI： 8.3-19.9）, which were statistically different from those in systemic chemotherapy group （both P 〈 0.01）. The patients could tolerate TACE combined with systemic chemotherapy. The common adverse effects were gastrointestinal reaction at grade 1-2, upper abdominal pain and leukopenia. Conclusion： TACE combined with systemic regimen for urothelial carcinoma patients chemotherapy is an efficacious and safe treatment with liver metastasis.