Husband D J, Green J A
Mersey Regional Centre for Radiotherapy and Oncology, Clatterbridge Hospital, Bebington, Wirral, U.K.
Eur J Cancer. 1992;28(1):86-91. doi: 10.1016/0959-8049(92)90392-f.
This study reports the outcome of POMB/ACE (cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, etoposide) chemotherapy in 53 male patients with metastatic non-seminomatous germ cell tumour (NSGCT) treated between 1983 and 1989 in one centre. The overall complete response (CR) rate was 62% [95% confidence interval (CI) 49-75%), and for patients with large or very large volume disease (L/VL, MRC criteria), the CR rate was 56% (95% CI 41-71%). The overall 5 year survival was 61%, and for L/VL volume disease 67%. Comparison with previous studies suggests that POMB/ACE chemotherapy is not superior to BEP, even in patients with adverse prognostic factors. Increased average relative dose intensity and increased relative dose intensity of cisplatin over the first seven courses were not associated with improved survival. However, in patients receiving a relative dose intensity of etoposide greater than or equal to 0.75, survival at 5 years was significantly improved compared with those in whom this parameter was less than 0.75 (79% vs. 44%, P less than 0.05), suggesting that dose intensity of etoposide may be an important determinant of outcome in the chemotherapy of metastatic NSGCT.
本研究报告了1983年至1989年在一个中心接受治疗的53例转移性非精原细胞瘤性生殖细胞肿瘤（NSGCT）男性患者采用POMB/ACE（顺铂、长春新碱、甲氨蝶呤、博来霉素、放线菌素D、环磷酰胺、依托泊苷）化疗的结果。总体完全缓解（CR）率为62%[95%置信区间（CI）49 - 75%]，对于疾病体积大或非常大（L/VL，MRC标准）的患者，CR率为56%（95%CI 41 - 71%）。总体5年生存率为61%，对于L/VL体积疾病患者为67%。与先前研究的比较表明，即使在具有不良预后因素的患者中，POMB/ACE化疗也不优于BEP。在前七个疗程中平均相对剂量强度增加和顺铂相对剂量强度增加与生存率提高无关。然而，接受依托泊苷相对剂量强度大于或等于0.75的患者与该参数小于0.75的患者相比，5年生存率显著提高（79%对44%，P小于0.05），这表明依托泊苷的剂量强度可能是转移性NSGCT化疗结果的一个重要决定因素。
