吉西他滨与顺铂辅助化疗联合手术治疗浸润性膀胱癌的疗效分析
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摘要
目的:探讨吉西他滨与顺铂(GC)方案辅助化疗联合经尿道膀胱肿瘤电切术(TURBt)或全膀胱切除术治疗浸润性膀胱癌的临床疗效。方法:明确诊断为浸润性膀胱癌患者35例,其中23例患者因不能耐受或者拒绝行全膀胱切除术而行保留膀胱的经尿道膀胱肿瘤电切术,12例患者行全膀胱切除术,其中9例行回肠通道术,3例行输尿管皮肤造口。5例全膀胱切除患者术前GC方案辅助化疗3个周期,另外7例患者术后GC方案先辅助化疗4个周期。23例患者TURBt后GC方案化疗4个周期,每3周为1个周期,同时行吡柔比星膀胱灌注化疗,每周1次,持续8周,以后每月1次,持续1年。每三个月复查膀胱镜及CT,评估肿瘤复发情况。结果:35例患者手术顺利,手术时间35~320 min。术后病理报告均为浸润性移行细胞癌,全膀胱切除患者切缘均为阴性。TURBt患者中1例肿瘤侵犯前列腺,全膀胱切除患者中1例肿瘤侵犯子宫,2例患者有1枚闭孔动脉旁淋巴结阳性。化疗后出现白细胞下降者20例,恶心、食欲减退等胃肠道反应者29例,对症处理后均好转。TURBt患者术后随访6~40个月,平均18个月,其中术后6个月复发者1例,12个月复发者1例,24个月复发者2例,30个月复发者2例,死亡1例,死于肿瘤远处转移。全膀胱切除患者随访12~26个月,未发现肿瘤局部复发或远处转移。结论:GC方案联合TURBt对浸润性膀胱癌有一定疗效,可作为保留膀胱的一种综合治疗方法,但仍有部分患者肿瘤复发,而GC方案联合全膀胱切除术能减少浸润性膀胱癌的复发。
Objective: To evaluate the clinical efficacy of gemcitabine and cisplatin( GC) adjuvant chemotherapy combined with transurethral resection of bladder tumor or radical cystectomy for invasive bladder cancer. Methods: Thirty-five patients were diagnosed invasive bladder cancer by Imaging and pathology. 23 patients,who refused or can not tolerate radical cystectomy were treated by TURBt; 12 patients were treated by radical cystectomy,9 cases were ileal conduit,3 cases were ureteral stoma. 5 patients treated by radical cystectomy received 3 cycles of GC neoadjuvant chemotherapy,other 7 patients received postoperative GC chemotherapy for 4 cycles. Pirarubicin intravesical chemotherapy for retention bladder patients once a week. Cystoscopy and CT every three months to review the assessment of tumor recurrence. Results: The tumors of 35 patients were resected completeiy. Operative time were 35 to 320 minutes. Pathological reports were invasive transitional cell carcinoma.Radical cystectomy in patients with negative margins. 1 case of tumor invasion of the prostate in TURBt patients,1 case of tumor invasion of the uterus and two cases had a positive lymph nodes near the obturator artery in radical cystectomy patients.After chemotherapy,20 cases were leukopenia,29 cases were nausea or loss of appetite or other gastrointestinal reactions,they were improved after symptomatic treatment. TURBt patients were followed up from 6 to 40 months,average of 18 months. 1 case recurrenced after 6 months,1 case recurrenced after 12 months,2 cases recurrenced after 24 months,2 cases recurrenced after30 months. 1 case died of tumor metastasis. Radical cystectomy patients were followed up from 12 to 26 months,no case recurrenced. Conclusion: GC regimen combined TURBt for invasive bladder cancer had a certain effect,can be retained as a comprehensive treatment of the bladder,but there were still some patients with tumor recurrence,while GC regimen combined with radical cystectomy can reduce invasive bladder cancer recurrence.
Objective: To evaluate the clinical efficacy of gemcitabine and cisplatin( GC) adjuvant chemotherapy combined with transurethral resection of bladder tumor or radical cystectomy for invasive bladder cancer. Methods: Thirty-five patients were diagnosed invasive bladder cancer by Imaging and pathology. 23 patients,who refused or can not tolerate radical cystectomy were treated by TURBt; 12 patients were treated by radical cystectomy,9 cases were ileal conduit,3 cases were ureteral stoma. 5 patients treated by radical cystectomy received 3 cycles of GC neoadjuvant chemotherapy,other 7 patients received postoperative GC chemotherapy for 4 cycles. Pirarubicin intravesical chemotherapy for retention bladder patients once a week. Cystoscopy and CT every three months to review the assessment of tumor recurrence. Results: The tumors of 35 patients were resected completeiy. Operative time were 35 to 320 minutes. Pathological reports were invasive transitional cell carcinoma.Radical cystectomy in patients with negative margins. 1 case of tumor invasion of the prostate in TURBt patients,1 case of tumor invasion of the uterus and two cases had a positive lymph nodes near the obturator artery in radical cystectomy patients.After chemotherapy,20 cases were leukopenia,29 cases were nausea or loss of appetite or other gastrointestinal reactions,they were improved after symptomatic treatment. TURBt patients were followed up from 6 to 40 months,average of 18 months. 1 case recurrenced after 6 months,1 case recurrenced after 12 months,2 cases recurrenced after 24 months,2 cases recurrenced after30 months. 1 case died of tumor metastasis. Radical cystectomy patients were followed up from 12 to 26 months,no case recurrenced. Conclusion: GC regimen combined TURBt for invasive bladder cancer had a certain effect,can be retained as a comprehensive treatment of the bladder,but there were still some patients with tumor recurrence,while GC regimen combined with radical cystectomy can reduce invasive bladder cancer recurrence.
引文
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[3]李双辉,张志宏,徐勇,等.根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析[J].中华泌尿外科杂志,2012,33(3):215-218.
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[5]曹明,赵宏,穆鑫,等.吉西他滨联合顺铂方案新辅助化疗联合全膀胱切除治疗肌层浸润性膀胱癌的9年回顾性分析[J].中华泌尿外科杂志,2014,35(1):49-53.
[6]薛坚留,潘宏铭.吉西他滨在晚期膀胱癌化疗中的应用[J].国外医学肿瘤学分册,2004(7):548-551.
[7]王亮,梁平,杨航,等.经尿道膀胱肿瘤电切术治疗复发性非肌层浸润性膀胱尿路上皮癌[J].现代泌尿生殖肿瘤杂志,2011,3(3):151-153.
[8]BENNER C,GREENBERG M,SHEPARD N,et al.The natural history of symptoms and distress for patients and families following cystectomy for treatment of muscle-invasive bladder cancer[J].J Urol,2014,191(4):937-942.
[9]ROGERS C G,PALAPATTU G S,SHARIAT S F,et al.Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder[J].J Urol,2006,175(6):2 048-2 053.
[10]COGNETTI F,RUGGERI E M,FELICI A,et al.Adjuvant chemotherapy with cisplatin and gemcitabine versus chemotherapy at relapse in patients with muscle-invasive bladder cancer submitted to radical cystectomy:an Italian,multicenter,randomized phaseⅢtrial[J].Ann Oncol,2012,23(3):695-700.
[11]汤钊猷.现代肿瘤学[M].2版.上海:上海医科大学出版社,2000,9:1 180-1 192.
[12]KAUFMAN D S.Challenges in the treatment of bladder cancer[J].An Oncol,2006,17(Suppl 5):106-112.
[2]HAUTMANN R E,PETRICONI R C,PFEIFFER C,et al.Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvent or adjuvant therapy:longterm results in 1100 patients[J].Eur Urol,2012,61(5):1 039-1 047.
[3]李双辉,张志宏,徐勇,等.根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析[J].中华泌尿外科杂志,2012,33(3):215-218.
[4]王勇,钟隆飞,李巧星,等.经尿道膀胱肿瘤电切联合化疗治疗浸润性膀胱癌(附20例报告)[J].现代泌尿生殖肿瘤杂志,2014,6(6):334-336.
[5]曹明,赵宏,穆鑫,等.吉西他滨联合顺铂方案新辅助化疗联合全膀胱切除治疗肌层浸润性膀胱癌的9年回顾性分析[J].中华泌尿外科杂志,2014,35(1):49-53.
[6]薛坚留,潘宏铭.吉西他滨在晚期膀胱癌化疗中的应用[J].国外医学肿瘤学分册,2004(7):548-551.
[7]王亮,梁平,杨航,等.经尿道膀胱肿瘤电切术治疗复发性非肌层浸润性膀胱尿路上皮癌[J].现代泌尿生殖肿瘤杂志,2011,3(3):151-153.
[8]BENNER C,GREENBERG M,SHEPARD N,et al.The natural history of symptoms and distress for patients and families following cystectomy for treatment of muscle-invasive bladder cancer[J].J Urol,2014,191(4):937-942.
[9]ROGERS C G,PALAPATTU G S,SHARIAT S F,et al.Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder[J].J Urol,2006,175(6):2 048-2 053.
[10]COGNETTI F,RUGGERI E M,FELICI A,et al.Adjuvant chemotherapy with cisplatin and gemcitabine versus chemotherapy at relapse in patients with muscle-invasive bladder cancer submitted to radical cystectomy:an Italian,multicenter,randomized phaseⅢtrial[J].Ann Oncol,2012,23(3):695-700.
[11]汤钊猷.现代肿瘤学[M].2版.上海:上海医科大学出版社,2000,9:1 180-1 192.
[12]KAUFMAN D S.Challenges in the treatment of bladder cancer[J].An Oncol,2006,17(Suppl 5):106-112.