摘要
目的探讨吉西他滨联合顺铂(GC方案)新辅助化疗在肌层浸润性膀胱癌中疗效及安全性。方法回顾性分析2016年1月至2020年5月于新疆医科大学第一附属医院行GC方案新辅助化疗2~3个周期后行根治性手术治疗的肌层浸润性膀胱癌患者39例,采用倾向得分匹配法(propensity score matching,PSM)与单纯行根治性手术治疗的62例肌层浸润性膀胱癌患者进行(1∶1)匹配,成功匹配39对。计算新辅助化疗患者的临床缓解率和病理降期率,并分析疗效与临床病理因素的相关性。计算总生存(overall survival,OS)和无进展生存(progression-free survival,PFS),分析OS、PFS与临床病理因素的相关性。采用单因素和多因素Logistic回归模型分析新辅助化疗的疗效影响因素。采用Kaplan-Meier法和Cox回归模型分析预后影响因素。结果新辅助化疗后39例患者的肿瘤最大径较化疗前缩小[(2.92±1.65)cm vs(2.34±2.29)cm,P=0.047],临床缓解率为46.2%,病理降期率为51.3%。新辅助化疗患者与单纯手术患者的1、2和3年OS和PFS率比较,差异均无统计学意义(均P>0.05)。肿瘤浸润淋巴脉管是PFS和OS的独立预后因素(均P<0.05)。39例患者中新辅助化疗后出现Ⅲ~Ⅳ度不良反应有4例(10.3%)。结论对于肌层浸润性膀胱癌患者,GC方案新辅助化疗能缩小肿瘤体积,有较高的临床缓解率和病理降期率。GC方案患者耐受良好,是临床上安全的膀胱癌新辅助化疗方案。
Objective To investigate the efficacy and safety of gemcitabine combined with cisplatin neoadjuvant chemotherapy in patients with muscular-infiltrating bladder cancer.Methods Thirty-nine patients with muscular-infiltrating bladder cancer who underwent radical surgery after 2 to 3 cycles of gemcitabine combined with cisplatin neoadjuvant chemotherapy in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2020 were retrospectively analyzed.Propensity score matching(PSM)was used to match 62 patients with muscular-infiltrating bladder cancer who underwent radical surgery alone(1∶1),and 39 pairs were successfully matched.The clinical remission rate and pathological downstaging rate of neoadjuvant chemotherapy patients were calculated,and the correlation between efficacy and clinicopathological factors was analyzed.Overall survival(OS)and progression-free survival(PFS)were calculated,and the correlations between OS,PFS and clinicopathological factors were analyzed.Univariate and multivariate logistic regression models were used to analyze the influencing factors of the efficacy of neoadjuvant chemotherapy,and Kaplan-Meier method and Cox regression model were used to analyze the prognostic factors.Results After neoadjuvant chemotherapy,the maximum tumor diameter[(2.92±1.65)cm vs(2.34±2.29)cm,P=0.047]was significantly reduced,the clinical remission rate was 46.2%,and the pathological downstaging rate was 51.3%.There was no significant difference in 1-,2-,and 3-year OS and PFS between the patients with neoadjuvant chemotherapy and those with surgery alone(all P>0.05).Lymphatic vascular invasion was an independent prognostic factor for OS and PFS(both P<0.05).GradeⅢ-Ⅳadverse reactions occurred in 4 patients(10.3%)after neoadjuvant chemotherapy.Conclusions For patients with muscular-infiltrating bladder cancer,gemcitabine combined with cisplatin neoadjuvant chemotherapy can significantly reduce the tumor volume,and has a high clinical remission rate and pathological downstaging rate.Gemcitabine combined with cisplatin is well tolerated by patients,and is a clinically safe neoadjuvant chemotherapy regimen for muscular-infiltrating bladder cancer.
作者
陈思婷
魏媛
斯热努尔·艾合买提
逯宋梅
热米拉·艾海提
张瑞丽
Chen Siting;Wei Yuan;Sirenuer Aihemaiti;Lu Songmei;Remila Aihaiti;Zhang Ruili(Department of Oncology,the First Affi liated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Oncology,Changji Branch of the First Affiliated Hospital of Xinjiang Medical University,Changji 831100,China;School of Health Management,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
出处
《实用肿瘤杂志》
CAS
2022年第5期457-464,共8页
Journal of Practical Oncology
基金
新疆维吾尔自治区自然科学基金项目(2019D01B49)。
关键词
肌层浸润性膀胱癌
新辅助化疗
疗效
预后
吉西他滨
顺铂
muscular-infiltrating bladder cancer
neoadjuvant chemotherapy
efficacy
prognosis
gemcitabine
cisplatin
