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目的评价吉西他滨联合顺铂三周方案治疗复发和转移性膀胱癌的疗效和安全性。方法GC组25例,吉西他滨1000mg/m2,静脉滴注,第1、8天;顺铂25mg/m2,静脉滴注,第1～3天,21d为1周期。MVAC组24例,甲氨蝶呤30mg/m2,静脉滴注,第1、15、22天;长春花碱3mg/m2,静脉滴注,第2、15、22天;阿霉素30mg/m2,静脉滴注,第2天;顺铂25mg/m2,静脉滴注,第1～3天,28d为1周期。至少化疗4个周期。结果GC组CR3例(12.0%),PR9例(36.0%),总有效率为48.0%。其中,初治组18例中CR2例(11.1%),PR7例(38.9%),有效率为50.0%;复治组7例中CR1例(14.3%),PR2例(28.6%),有效率为42.9%。MVAC组CR2例(8.3%),PR8例(33.3%),总有效率为41.7%。其中,初治组16例中CR2例(12.5%),PR6例(37.5%),有效率为50.0%;复治组8例中无CR,PR2例,有效率为25.0%。两组比较差异无统计学意义(χ2=0.199,P=0.656)。GC组1,2年生存率分别为76.0%和16.0%;MVAC组1,2年生存率分别为75.0%和8.3%。GC、MVAC组中位生存期分别为16个月(95%CI13.55～18.45)和16个月(95%CI14.11～17.89)。Ⅲ/Ⅳ度血小板减少症、皮疹、疲乏GC组高于MVAC组;Ⅲ/Ⅳ度中性粒细胞减少、中性粒细胞减少性发热,恶心、呕吐等毒副反应MVAC组高于GC组,两组比较差异无显著性(P>0.05)。结论吉西他滨联合顺铂三周方案化疗治疗复发和转移性膀胱癌具有与标准MVAC方案相似的疗效,且更安全。
Objective To evaluate the efficacy and safety of gemcitabine combined with cisplatin in the treatment of recurrent and metastatic bladder cancer. Methods 25 cases of GC group, gemcitabine 1000mg / m2, intravenous drip, first and eighth days; cisplatin 25mg / m2, intravenous infusion, 1 to 3 days, 21d for a cycle. MVAC group 24 cases, methotrexate 30mg / m2, intravenous drip, the first day, 15,22 days; vinblastine 3mg / m2, intravenous drip, 2,15,22 days; doxorubicin 30mg / m2 , Intravenous drip, the first two days; cisplatin 25mg / m2, intravenous infusion, 1 to 3 days, 28d for a cycle. At least 4 cycles of chemotherapy. Results In GC group, CR3 (12.0%) and PR9 (36.0%) had a total effective rate of 48.0%. Among them, CR2 (11.1%), PR7 (38.9%) were effective in 18 cases of primary treatment group and 50.0% in 7 cases of remission treatment group, CR1 cases (14.3%) and PR2 cases (28.6% 42.9%. MVAC CR2 cases (8.3%), PR8 cases (33.3%), the total effective rate was 41.7%. Among them, CR2 (12.5%), PR6 (37.5%) were effective in 16 cases of CR and 50.0% of PR, respectively. There were no CR and PR2 cases in CRP, and the effective rate was 25.0%. There was no significant difference between the two groups (χ2 = 0.199, P = 0.656). The 1-year and 2-year survival rates of GC group were 76.0% and 16.0%, respectively. The 1-year and 2-year survival rates of MVAC group were 75.0% and 8.3%, respectively. The median survival time of GC and MVAC patients were 16 months (95% CI 13.55-18.45) and 16 months (95% CI 14.11-17.89) respectively. Ⅲ / Ⅳ degree thrombocytopenia, rash, fatigue GC group was higher than MVAC group; Ⅲ / Ⅳ neutropenia, neutropenic fever, nausea, vomiting and other side effects of MVAC group was higher than the GC group, There was no significant difference between the two groups (P> 0.05). Conclusion Gemcitabine combined with cisplatin three weeks regimen in the treatment of recurrent and metastatic bladder cancer has similar efficacy and safety as the standard MVAC regimen.