Pedersen-Bjergaard J, Ersbøll J, Hansen V L, Sørensen B L, Christoffersen K, Hou-Jensen K, Nissen N I, Knudsen J B, Hansen M M
Department of Internal Medicine and Hematology, Finsen Institute-Rigshospitalet, Copenhagen, Denmark.
N Engl J Med. 1988 Apr 21;318(16):1028-32. doi: 10.1056/NEJM198804213181604.
We observed nine cases of transitional-cell carcinoma of the urinary bladder among patients who had had long-term treatment of other cancers with cyclophosphamide. Seven of the bladder carcinomas occurred within a cohort of 471 patients treated for non-Hodgkin's lymphomas. In this cohort the relative risk of bladder cancer was 6.8 (95 percent confidence interval, 3.2 to 14.2). The cumulative risk (mean +/- SE) was 3.5 +/- 1.8 percent 8 years after the start of treatment with cyclophosphamide and 10.7 +/- 4.9 percent after 12 years. Three of the nine patients were 50 years of age or younger; seven died with progressive bladder cancer. Subsequently, an additional patient had acute nonlymphocytic leukemia. Hemorrhagic cystitis was observed in 33 patients (cumulative risk, 11.8 +/- 2.1 percent after five years). Development of carcinoma of the urinary bladder was not related to previous hemorrhagic cystitis. The results caution against long-term treatment with cyclophosphamide for diseases with a favorable prognosis.
我们在长期接受环磷酰胺治疗其他癌症的患者中观察到9例膀胱移行细胞癌。其中7例膀胱癌发生在471例接受非霍奇金淋巴瘤治疗的患者队列中。在该队列中，膀胱癌的相对风险为6.8（95%置信区间为3.2至14.2）。环磷酰胺治疗开始8年后的累积风险（均值±标准误）为3.5±1.8%，12年后为10.7±4.9%。9例患者中有3例年龄在50岁及以下；7例死于进展性膀胱癌。随后，又有1例患者患急性非淋巴细胞白血病。33例患者出现出血性膀胱炎（5年后累积风险为11.8±2.1%）。膀胱癌的发生与既往出血性膀胱炎无关。这些结果警示不要对预后良好的疾病长期使用环磷酰胺治疗。
