CAJ | 학술논문

目的探讨吉西他滨与顺铂新辅助化疗治疗肌层浸润性膀胱癌的疗效.方法我院74例肌层浸润性膀胱癌T3 ～T4a期患者,其中34例患者直接行膀胱全切术,其余40例不愿直接行膀胱全切的患者接受2个周期的髂内动脉吉西他滨与顺铂新辅助化疗,化疗后膀胱镜活检,11例稳定或进展患者行膀胱全切,24例降级至T0 ～ T1期的患者继续接受3个疗程吉西他滨与顺铂全身化疗,之后进行经尿道电切,5例降级至T2 ～ T3期的患者接受膀胱全切.比较各组患者以及直接膀胱全切组患者肿瘤特异性生存率、总生存率以及膀胱保存率.结果 GC组对GC治疗的总的反应率为51.6％,完全反应率为26.3％.3年总生存率在化疗组为49.7％,无化疗组为49.3％(P＞0.05).3年无进展生存率在化疗组为34.9％,无化疗组为41.1％ (P ＞0.05).接受新辅助化疗组中24.2％的患者保留了膀胱,化疗有反应的患者中总生存率为76.0％,完全反应的患者中总生存率为100.0％.结论本组GC新辅助化疗治疗非转移性的肌层浸润性膀胱癌,与直接接受根治手术的患者比较,随访3年并不提高总生存率(OS)和疾病无进展生存率(PFS),但是相当比例的患者得以保留膀胱.
목적 탐토길서타빈여순박신보조화료치료기층침윤성방광암적료효.방법 아원74례기층침윤성방광암T3 ～T4a기환자,기중34례환자직접행방광전절술,기여40례불원직접행방광전절적환자접수2개주기적가내동맥길서타빈여순박신보조화료,화료후방광경활검,11례은정혹진전환자행방광전절,24례강급지T0 ～ T1기적환자계속접수3개료정길서타빈여순박전신화료,지후진행경뇨도전절,5례강급지T2 ～ T3기적환자접수방광전절.비교각조환자이급직접방광전절조환자종류특이성생존솔、총생존솔이급방광보존솔.결과 GC조대GC치료적총적반응솔위51.6％,완전반응솔위26.3％.3년총생존솔재화료조위49.7％,무화료조위49.3％(P＞0.05).3년무진전생존솔재화료조위34.9％,무화료조위41.1％ (P ＞0.05).접수신보조화료조중24.2％적환자보류료방광,화료유반응적환자중총생존솔위76.0％,완전반응적환자중총생존솔위100.0％.결론 본조GC신보조화료치료비전이성적기층침윤성방광암,여직접접수근치수술적환자비교,수방3년병불제고총생존솔(OS)화질병무진전생존솔(PFS),단시상당비례적환자득이보류방광.
Objective To investigate the effectiveness of gemcitabine and cisplatin as neoadjuvent chemotherapy for muscle-invasive bladder cancer.Methods Seventy-four cases of muscle invasive bladder cancer,staging T3-T4a were recruited.Thirty-four cases received radical cystectomy (RC).The rest 40 cases who were not willing to receive RC received 2 cycles of gemcitabine and cisplatin neoadjuvent chemotherapy followed by cystoscopy biopsy:11 cases were stable or with progression,who received RC:24 cases lowered to T0-T1,and they received 3 cycles of gemcitabine and cisplatin systemic chemotherapy again and then received trans-urethra resection of bladder tumor;cases lowered to T2-T3,and received RC.Tumor specific survival rate,overall survival rate,as well as bladder preservation rate of different groups was compared.Results In gemcitabine + cisplatin group,overall response rate was 51.6％,and complete reaction rate was 26.3％.Three-year overall survival rate in gemcitabine + cisplatin group was 49.7％,and 49.3％ in control group (P ＞ 0.05).Three-year progression-free survival in gemcitabine + cisplatin group was 34.9％,and that in control group was 41.1％ (P ＞ 0.05).The bladder in 24.2％ of the patients in gemcitabine + cisplatin group was preserved.Overall survival rate in patients with response was 76.0％,and 100.0％ in complete response patients.Conclusion During a follow-up period of 3 years,the oservall suvival and progression-free survival were not increased by gemcitabine and cisplatin neoadjuvent chemotherapy for muscle invasive bladder carcinoma in comparison to the RC,but the bladder in relative proportion of patients is preserved.