新辅助化疗与辅助化疗治疗肌层浸润性膀胱癌的疗效比较

邓康俐; 崔殿生; 贾全安; 刘三河; 黄雷; 魏少忠

doi:10.3971/j.issn.1000-8578.2019.18.1002

新辅助化疗与辅助化疗治疗肌层浸润性膀胱癌的疗效比较

Clinical Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy on Muscle-invasive Bladder Cancer

摘要

摘要:
目的对接受新辅助和辅助化疗的膀胱癌患者临床疗效进行对比，为化疗时机的选择作初步探索。
方法回顾性研究湖北省肿瘤医院2009—2016年诊断为肌层浸润性膀胱癌并在全膀胱术前（新辅助）或术后（辅助）接受了GC方案化疗的患者。主要研究终点是无复发生存期（recurrence-free survival, RFS）。次要研究终点是临床完全缓解率（complete response, CR）。
结果共38例肌层浸润性膀胱癌患者纳入研究（22例新辅助+16例辅助）。在中位随访时间点时，新辅助和辅助化疗组的RFS相比较差异无统计学意义（69.6% vs.75.4%, P=0.223）。在中位随访时间点上接受新辅助化疗后病理完全缓解组（pT0）与非完全缓解组（non-pT0）的RFS分别为100%和50%（P=0.012），差异有统计学意义。两组患者在接受化疗治疗后出现3~4级严重血液学不良反应的人数比例相比较差异无统计学意义（P=0.36）。
结论接受新辅助或辅助化疗的肌层浸润性膀胱癌患者的RFS相比较差异无统计学意义，新辅助化疗后达到病理完全缓解的患者均未出现肿瘤复发，但尚需更多的研究来证实。

Abstract:
Objective To compare the clinical outcomes of neoadjuvant versus adjuvant chemotherapy on muscle-invasive bladder cancer patients.
Methods We retrospectively reviewed the muscle-invasive bladder cancer patients who were treated with radical cystectomy plus neoadjuvant or adjuvant chemotherapy from 2009 to 2016 in Hubei Cancer Hospital. The primary endpoint was recurrence-free survival (RFS). The secondary endpoint was clinical complete response (CR).
Results A total of 38 muscle-invasive bladder cancer patients were included: 22 patients received neoadjuvant chemotherapy and 16 patients received adjuvant chemotherapy. The RFS at median follow-up time was not significantly different between neoadjuvant and adjuvant groups (69.6% vs. 75.4%, P=0.223). The RFS at median follow-up time between maid patients with pT0 and non-pT0 were significantly different (100% vs. 50%, P=0.012). The incidence rates of grade 3 or 4 thrombocytopenia, anemia and neutropenia were not significantly different between the two groups (P=0.36).
Conclusion There is no significant difference in RFS between neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer patients treated with radical cystectomy. No recurrence occurs in the patients who achieve pT0 in neoadjuvant chemotherapy group. Further investigations are needed to confirm our results.

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