Goel Sunny, Sinha Rahul J, Bhaskar Ved, Aeron Ruchir, Sharma Ashish, Singh Vishwajeet
Department of Urology, King George Medical University, Lucknow, India.
Asian J Urol. 2019 Jul;6(3):222-229. doi: 10.1016/j.ajur.2018.06.006. Epub 2018 Jun 25.
Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer. In the last decade, interest in neoadjuvant chemotherapy has slowly shifted from methotrexate, vinblastine, doxorubicin and cisplatin regime to gemcitabine and cisplatin regime. There are many publications on gemcitabine and cisplatin regime in literature which cover different aspects of treatment. This review aims to summarise the findings published so far on gemcitabine and cisplatin regime and present it in a concise manner.
A systematic literature review was conducted searching the PubMed database in December 2016 using the medical subject heading (MeSH) with the terms gemcitabine, cisplatin, chemotherapy, muscle invasive bladder cancer, and neoadjuvant. All relevant studies were included and results were analysed.
A total of 13 studies were included which published between 2007 and 2015. These 13 studies comprised of 754 subjects suffering from muscle invasive bladder cancer. The proportion of male patients ranged from 60% to 86.4% and the median age ranged from 54.2 to 77.3 years in various studies. Complete pathological response (pT0) was seen in 30.0% of patients and pathological downstaging (<pT2) was seen in 48.67% of patients.
As per latest guidelines, neoadjuvant chemotherapy is recommended for patients with muscle invasive bladder cancer. There is substantial pathological downstaging with low toxicity in patients of muscle invasive bladder cancer who receive neoadjuvant gemcitabine and cisplatin regime.
新辅助化疗后行根治性膀胱切除术被认为是肌层浸润性膀胱癌患者的标准治疗方案。在过去十年中，对新辅助化疗的关注已逐渐从甲氨蝶呤、长春花碱、阿霉素和顺铂方案转向吉西他滨和顺铂方案。文献中有许多关于吉西他滨和顺铂方案的出版物，涵盖了治疗的不同方面。本综述旨在总结迄今为止发表的关于吉西他滨和顺铂方案的研究结果，并以简洁的方式呈现。
2016年12月，使用医学主题词（MeSH）在PubMed数据库中进行系统文献检索，检索词为吉西他滨、顺铂、化疗、肌层浸润性膀胱癌和新辅助。纳入所有相关研究并分析结果。
共纳入2007年至2015年间发表的13项研究。这13项研究包括754例肌层浸润性膀胱癌患者。在各项研究中，男性患者的比例在60%至86.4%之间，中位年龄在54.2至77.3岁之间。30.0%的患者出现完全病理缓解（pT0），48.67%的患者出现病理降期（<pT2）。
根据最新指南，推荐对肌层浸润性膀胱癌患者进行新辅助化疗。接受新辅助吉西他滨和顺铂方案的肌层浸润性膀胱癌患者有显著的病理降期且毒性较低。
