Schinzari Giovanni, Monterisi Santa, Pierconti Francesco, Nazzicone Giulia, Marandino Laura, Orlandi Armando, Racioppi Marco, Cassano Alessandra, Bassi Pierfrancesco, Barone Carlo, Rossi Ernesto
Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.
Anticancer Res. 2017 Nov;37(11):6453-6458. doi: 10.21873/anticanres.12100.
Neoadjuvant chemotherapy demonstrated a survival benefit versus cystectomy alone in muscle-invasive urothelial bladder cancer. Despite this advantage, preoperative chemotherapy is not widely employed. When patients are unfit for cisplatin-based regimen, they are often candidates for immediate surgery. In our study, patients with muscle-invasive bladder cancer were treated with neoadjuvant chemotherapy. The principal objective was the rate of complete pathological response (pCR). Secondary end-points were disease-free survival (DFS), overall survival (OS) and toxicity.
Patients (n=72) with Eastern Cooperative Oncology Group (ECOG) performance status 0-1, clinical stage cT3-4, and/or N+ muscle-invasive bladder cancer were enrolled. The chemotherapy regimen was established according to the cisplatin feasibility. Thirty patients were treated with cisplatin/gemcitabine (Gem) and 42 with carboplatin/Gem.
The rate of pCR was 29.2%, 36% with cisplatin-based treatment and 23.8% with carboplatin (p=0.3574). DFS and OS were longer in pCR patients, while no difference was reported between cisplatin/Gem and Carboplatin/Gem groups.
Our results confirm the prognostic value of pCR in neoadjuvant chemotherapy for muscle-invasive bladder cancer. When the patients are not fit for cisplatin, a carboplatin/Gem regimen represents a valid option because of comparable long-term outcome. When cisplatin is not feasible, the exclusion of a preoperative treatment is not justified.
在肌层浸润性尿路上皮膀胱癌中，新辅助化疗相较于单纯膀胱切除术显示出生存获益。尽管有此优势，但术前化疗并未广泛应用。当患者不适合基于顺铂的方案时，他们通常是直接手术的候选者。在我们的研究中，肌层浸润性膀胱癌患者接受了新辅助化疗。主要目标是完全病理缓解（pCR）率。次要终点是无病生存期（DFS）、总生存期（OS）和毒性。
纳入东部肿瘤协作组（ECOG）体能状态为0 - 1、临床分期为cT3 - 4和/或N + 的肌层浸润性膀胱癌患者（n = 72）。根据顺铂的可行性确定化疗方案。30例患者接受顺铂/吉西他滨（Gem）治疗，42例接受卡铂/Gem治疗。
pCR率为29.2%，基于顺铂的治疗为36%，卡铂治疗为23.8%（p = 0.3574）。pCR患者的DFS和OS更长，而顺铂/Gem组和卡铂/Gem组之间未报告差异。
我们的结果证实了pCR在肌层浸润性膀胱癌新辅助化疗中的预后价值。当患者不适合顺铂时，卡铂/Gem方案由于长期结果相当，是一个有效的选择。当顺铂不可行时，不进行术前治疗是不合理的。
