程序性细胞死亡受体-1抑制剂联合化疗新辅助治疗肌层浸润性膀胱癌的应用研究

Application of programmed death 1 inhibitors combined neoadjuvant chemotherapy in the treatment of muscle-invasive bladder cancer

目的评价程序性细胞死亡受体-1(programmed death 1,PD-1)抑制剂联合化疗新辅助治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的疗效、安全性及膀胱保留情况。方法回顾性分析2020年8月~2022年5月就诊于哈尔滨医科大学附属肿瘤医院行PD-1抑制剂联合化疗新辅助治疗的15例肌层浸润性膀胱癌患者的临床资料,病理诊断为膀胱尿路上皮癌,无远处转移。采用吉西他滨、顺铂联合卡瑞利珠单抗方案。分析患者完全缓解(complete remission,CR)率、部分缓解(partial remission,PR)率、无进展生存期(progression-free survival,PFS)、不良反应及膀胱保留率。结果所有患者中,5例达到CR,客观缓解率(objective response rate,ORR)为53.3%(8/15),疾病控制率(disease control rate,DCR)为80%(12/15),膀胱保留率为64.3%(9/14)。不良反应主要为恶心、呕吐、血红蛋白下降和胆固醇升高等。结论PD-1抑制剂联合化疗新辅助治疗肌层浸润性膀胱癌疗效显著,同时为部分肌层浸润性膀胱癌患者实现了保留膀胱的目的,所有不良反应均可耐受。

Objective To explore the effectiveness,safety and bladder preservation rate of programmed death 1(PD-1)combined with neoadjuvant chemotherapy in the treatment of muscle-invasive bladder cancer(MIBC).Methods The clinical data of 15 patients with MIBC who received PD-1 inhibitor combined with neoadjuvant chemotherapy in Harbin Medical University Cancer Hospital from August 2020 to May 2022 were retrospectively analyzed.All the patients were pathologically diagnosed as bladder uroepithelial carcinoma without distant metastasis.Gascotabin,cisplatin combined with camrelizumab were used.The complete remission(CR)rate,partial remission(PR)rate,progress-free survival(PFS),objective response rate(ORR)and disease control rate(DCR)were analyzed.Results Five patients achieved CR.Objective response rate was 53.3%(8/15),disease control rate was 80%(12/15),and bladder retention rate was 64.3%(9/14).The main adverse reactions were nausea,vomiting,decreased hemoglobin and elevated cholesterol.Conclusion The efficacy of PD-1 inhibitor combined with neoadjuvant chemotherapy for MIBC is significant,the purpose of bladder preservation was achieved for some MIBC patients,and all adverse reactions are tolerated.