Lehmann Jan, Retz Margitta, Stöckle Michael
Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421 Homburg/Saar, Germany.
World J Urol. 2002 Aug;20(3):144-50. doi: 10.1007/s00345-002-0252-9. Epub 2002 Feb 27.
Radical cystectomy for muscle invasive and locally advanced bladder cancer is the standard treatment modality in most of the Western industrialised countries. Rates of perioperative mortality from radical cystectomy have decreased to less than 2% over the past two decades due to advances in surgical technique and perioperative care. However, at least 40% of patients with pT3 bladder cancer and 70% of patients with lymph node-positive disease develop tumour recurrence after radical treatment within the first 5 years when treated with radical cystectomy alone. After the efficacy of combination chemotherapy for metastatic urothelial cancer using methotrexate, vinblastine, adriamycin and cisplatin (MVAC) was first described in 1985, several cisplatin-based systemic regimens have been investigated as adjunctive treatment before or after therapy for locally advanced bladder cancer by radical surgery or radiation therapy. Three randomised studies have reported superior results of postoperative adjuvant systemic chemotherapy compared to radical cystectomy alone for locally advanced bladder cancer. All three studies demonstrated a significant survival benefit for bladder cancer patients receiving adjuvant combination therapy. Studies have been criticised for small patient numbers and statistical shortcomings. New effective antineoplastic agents, such as paclitaxel and gemcitabine, have evolved during the past decade as promising substances for the treatment of urothelial cancer. This article reviews adjuvant studies from the era of MVAC combination chemotherapy, as well as contemporary studies that discuss new antineoplastic agents for systemic adjuvant chemotherapy of locally advanced bladder cancer.
对于肌肉浸润性和局部晚期膀胱癌，根治性膀胱切除术是大多数西方工业化国家的标准治疗方式。在过去二十年中，由于手术技术和围手术期护理的进步，根治性膀胱切除术的围手术期死亡率已降至2%以下。然而，单独接受根治性膀胱切除术治疗的患者中，至少40%的pT3期膀胱癌患者和70%的淋巴结阳性疾病患者在根治性治疗后的前5年内会出现肿瘤复发。1985年首次描述了使用甲氨蝶呤、长春花碱、阿霉素和顺铂（MVAC）联合化疗治疗转移性尿路上皮癌的疗效后，几种基于顺铂的全身治疗方案已被研究作为局部晚期膀胱癌根治性手术或放射治疗前后的辅助治疗。三项随机研究报告称，对于局部晚期膀胱癌，术后辅助全身化疗的效果优于单独的根治性膀胱切除术。所有三项研究都表明，接受辅助联合治疗的膀胱癌患者有显著的生存获益。这些研究因患者数量少和统计缺陷而受到批评。在过去十年中，新的有效抗肿瘤药物，如紫杉醇和吉西他滨，已成为治疗尿路上皮癌的有前景的药物。本文回顾了MVAC联合化疗时代的辅助治疗研究，以及讨论用于局部晚期膀胱癌全身辅助化疗的新抗肿瘤药物的当代研究。
