Raghavan Derek, Quinn David, Skinner Donald G, Stein John P
Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Room 3446, Los Angeles, CA 90033, USA.
Surg Oncol. 2002 Jun;11(1-2):55-63. doi: 10.1016/s0960-7404(02)00007-5.
Invasive bladder cancer has a predilection for early, occult metastasis. Despite effective local control from radiotherapy or cystectomy, approximately 50% of the patients with clinically localized, invasive bladder cancer ultimately die of their disease. Over the past 25 years, systemic chemotherapy has been combined with definitive local treatment in an attempt to improve cure rates. Non-randomized phase I-II trials have shown promising results, with significant tumor down-staging. However, many randomized trials have failed to show a statistically significant survival benefit from adjunctive systemic chemotherapy. Recently, two intergroup randomized trials have shown a survival benefit from neoadjuvant combination chemotherapy, although the differences between the arms have not been dramatic. Adjuvant chemotherapy trials to date have failed to show statistically improved survival, although most published studies have been methodologically flawed. This review analyzes the results of published data and constructs a practical paradigm for patient management.
浸润性膀胱癌易于早期发生隐匿性转移。尽管放疗或膀胱切除术可实现有效的局部控制，但约50%临床局限性浸润性膀胱癌患者最终死于该疾病。在过去25年中，全身化疗已与确定性局部治疗联合应用，试图提高治愈率。非随机的I-II期试验已显示出有前景的结果，肿瘤有显著降期。然而，许多随机试验未能显示辅助性全身化疗具有统计学上显著的生存获益。最近，两项组间随机试验显示新辅助联合化疗有生存获益，尽管两组之间的差异并不显著。迄今为止，辅助化疗试验未能显示出生存率有统计学上的改善，尽管大多数已发表的研究在方法上存在缺陷。本综述分析已发表数据的结果，并构建一个实用的患者管理模式。
