THE PROGNOSTIC VALUE OF THE PATHOLOGICAL RESPONSE TO COMBINATION CHEMOTHERAPY BEFORE CYSTECTOMY IN PATIENTS WITH INVASIVE BLADDER-CANCER
THE PROGNOSTIC VALUE OF THE PATHOLOGICAL RESPONSE TO COMBINATION CHEMOTHERAPY BEFORE CYSTECTOMY IN PATIENTS WITH INVASIVE BLADDER-CANCER
复制标题
DOI：
10.1016/s0022-5347(17)37318-4
复制
发表时间：
1992-03-01
影响因子：
6.6
通讯作者：
HERR, H
中科院分区：
文献类型：
--
作者：
SPLINTER, TAW;SCHER, HI;HERR, H
回顾性评估了147例深度浸润性膀胱移行细胞癌患者对联合化疗的病理反应的预后价值。数据来自8个不同的研究中心。如果患者接受了静脉联合化疗，随后接受部分、全部或根治性化疗，并且在化疗开始后至少随访2年，则患者符合条件。90%的患者接受了甲氨蝶呤、长春碱、多柔比星和顺铂（M-VAC）或顺铂加甲氨蝶呤，中位疗程为3个（范围1至6个）。在分析时存活的83例患者中，精算中位随访时间为30.5个月（范围13.2 - 85.6个月）。在41.5%的患者中实现了主要病理学缓解（P0、Pis、Pa或P1期）。主要病理学反应患者（p分期小于2）的5年生存率为75%，而其余无反应患者（p分期2或以上）的5年生存率为20%。具有主要病理学缓解的患者的生存率与缓解是否由2个或更多个疗程的化疗诱导或与顺铂+甲氨蝶呤相比是否由M-VAC诱导无关。术前临床评估可以正确识别无反应的患者，在这些情况下，需要替代治疗方案，因为80%的患者会死于这种疾病。此外，如果新辅助化疗被证明可以提高生存率，则数据强调了原发肿瘤缓解率的重要性，并需要研究诱导最佳缓解的最佳疗程数，最好是在个体患者中。
The prognostic value of the pathological response to combination chemotherapy of deeply invasive transitional cell cancer of the bladder was retrospectively assessed in 147 patients. Data were collected from 8 different centers. Patients were eligible if they had received intravenous combination chemotherapy followed by partial, total or radical cystectomy, and if they had a minimum followup of 2 years after the start of chemotherapy. Of the patients 90% received methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) or cisplatin plus methotrexate for a median of 3 courses (range 1 to 6). Of the 83 patients who were alive at analysis actuarial median followup was 30.5 months (range 13.2 to 85.6 months). A major pathological response (stage P0, Pis, Pa or P1) was achieved in 41.5% of the patients. Patients with a major pathological response (p stage less than 2) had a 5-year survival of 75% in contrast to 20% for the remaining nonresponding patients (p stage 2 or more). The survival of patients with a major pathological response was independent of whether the response was induced by 2 or more courses of chemotherapy, or whether it was induced by M-VAC in comparison with cisplatin plus methotrexate. Preoperative clinical assessments can identify nonresponding patients correctly and in these cases alternative treatment programs are required, since 80% will die of the disease. Moreover, if neoadjuvant chemotherapy is proved to increase survival, the data emphasize the importance of the response rate of the primary tumor and the need to investigate the optimal number of courses to induce the best response, preferably in the individual patient.