Pouessel Damien, Chevret Sylvie, Rolland Frédéric, Gravis Gwenaelle, Geoffrois Lionel, Roubaud Guilhem, Terrisse Safae, Boyle Helen, Chevreau Christine, Dauba Jérôme, Moriceau Guillaume, Alexandre Ingrid, Deplanque Gaël, Chapelle Angélique, Vauleon Elodie, Colau Alexandre, Audenet François, Grellety Thomas, Culine Stéphane
Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France.
Department of Biostatistics and Medical Information, Hôpital Saint-Louis, AP-HP, Paris, France; Inserm, UMR 717, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France.
Eur J Cancer. 2016 Feb;54:69-74. doi: 10.1016/j.ejca.2015.11.017. Epub 2015 Dec 25.
There is continuing controversy regarding the optimal regimen for neoadjuvant chemotherapy (NAC) in bladder cancer.
We performed a retrospective analysis of 241 consecutive bladder cancer patients who received a combination of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) using a standard (52 patients) or an accelerated schedule (189 patients) as NAC before radical cystectomy in 17 centres of the French GEnito-urinary TUmour Group from March 2004-May 2013.
The median age was 62 years. As expected, the median number of cycles, the median total dose of cisplatin and the median cisplatin dose intensity were higher in patients treated with the accelerated regimen. Conversely, the median duration of chemotherapy was shorter. Regarding toxicity, grade III/IV neutropenia, grade III thrombocytopenia and grade III anaemia as well were more frequently observed in patients treated with the standard regimen. Among 211 (88%) patients who proceeded to cystectomy, 75 (35%) patients achieved an ypT0 pN0 status (no pathologic residual tumour cells) with no significant difference according to the MVAC schedule. Three-year overall survival rates were 66.5% (95% confidence interval [CI], 56-79) and 72% (95% CI, 59.5-88) in the standard and accelerated cohorts, respectively. In the multivariate analysis, two independent prognostic parameters were retained: the ypT0 stage and the ypN0 stage. Heterogeneity test did not show any interaction with NAC regimens.
Similar pathological response and survival rates were observed whatever the chemotherapy regimen used. Haematological toxicity was greater in patients who received standard MVAC.
关于膀胱癌新辅助化疗（NAC）的最佳方案一直存在争议。
我们对241例连续的膀胱癌患者进行了回顾性分析，这些患者在2004年3月至2013年5月期间于法国泌尿生殖肿瘤组的17个中心接受了甲氨蝶呤、长春碱、阿霉素和顺铂（MVAC）联合治疗，其中52例采用标准方案，189例采用加速方案作为根治性膀胱切除术之前的NAC。
中位年龄为62岁。正如预期的那样，接受加速方案治疗的患者的中位周期数、顺铂总剂量中位数和顺铂剂量强度中位数更高。相反，化疗的中位持续时间更短。关于毒性，标准方案治疗的患者更频繁地观察到III/IV级中性粒细胞减少、III级血小板减少和III级贫血。在211例（88%）接受膀胱切除术的患者中，75例（35%）患者达到ypT0 pN0状态（无病理残留肿瘤细胞），根据MVAC方案无显著差异。标准组和加速组的三年总生存率分别为66.5%（95%置信区间[CI]，56 - 79）和72%（95%CI，59.5 - 88）。在多变量分析中，保留了两个独立的预后参数：ypT0期和ypN0期。异质性检验未显示与NAC方案有任何相互作用。
无论使用何种化疗方案，观察到的病理反应和生存率相似。接受标准MVAC的患者血液学毒性更大。
