比较吉西他滨-顺铂新辅助化疗联合大剂量强度 MVAC 治疗局限性或局部晚期尿路上皮癌患者的临床结局。
Comparison of clinical outcomes in patients with localized or locally advanced urothelial carcinoma treated with neoadjuvant chemotherapy involving gemcitabine-cisplatin and high dose-intensity MVAC.
机构信息
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
出版信息
J Cancer Res Clin Oncol. 2021 Nov;147(11):3421-3429. doi: 10.1007/s00432-021-03582-x. Epub 2021 Mar 14.
PURPOSE
To compare the efficacy and safety of high dose-intensity combination of methotrexate, vinblastine, adriamycin and cisplatin (HD MVAC) with gemcitabine plus cisplatin (GC) as a neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer (MIBC) or locally advanced upper tract urothelial cancer (UTUC).
PATIENTS AND METHODS
A retrospective analysis was conducted for patients with UC (cT2-4aN0-1M0) who received NAC from January 2011 and December 2017 at Asan Medical Center. Pathologic complete response (pCR), down-staging (< ypT2 and no N upstaging), disease-free survival (DFS), OS and safety were compared for each regimen.
RESULTS
Out of a total of 277 patients, 176 patients received GC and 41 patients received HD MVAC. With the exception of age (patients receiving HD MVAC were younger; p = 0.002), other baseline characteristics were well balanced between groups. pCR rates were 27.0% for GC and 22.6% for HD MVAC (p = 0.62), and down-staging rate was 50.8% for GC and 58.1% for HD MVAC (p = 0.47). There were no differences in OS (72.1% vs 73.1% for GC vs HD MVAC; p = 0.58) and DFS (54.9% vs 63.3% for GC vs HD MVAC; p = 0.21) at 3 years. HD MVAC with prophylactic G-CSF was associated with a higher incidence of febrile neutropenia (p < 0.001) than GC. The NAC regimen was not an independent prognostic factor for OS.
CONCLUSION
Oncologic outcomes were not significantly different between the GC and HD MVAC when used as NAC in MIBC/UTUC.
目的
比较高剂量强度甲氨蝶呤、长春碱、阿霉素和顺铂（HD-MVAC）联合吉西他滨和顺铂（GC）作为新辅助化疗（NAC）在肌层浸润性膀胱癌（MIBC）或局部晚期上尿路上皮癌（UTUC）中的疗效和安全性。
方法
对 2011 年 1 月至 2017 年 12 月期间在 Asan 医疗中心接受 NAC 的 UC（cT2-4aN0-1M0）患者进行回顾性分析。比较两种方案的病理完全缓解率（pCR）、降期（<ypT2 且无 N 分期升级）、无病生存期（DFS）、总生存期（OS）和安全性。
结果
共 277 例患者，176 例接受 GC 治疗，41 例接受 HD-MVAC 治疗。除年龄（接受 HD-MVAC 的患者年龄较小；p=0.002）外，两组间其他基线特征均衡。GC 组的 pCR 率为 27.0%，HD-MVAC 组为 22.6%（p=0.62），降期率 GC 组为 50.8%，HD-MVAC 组为 58.1%（p=0.47）。3 年时 OS（GC 组为 72.1%，HD-MVAC 组为 73.1%；p=0.58）和 DFS（GC 组为 54.9%，HD-MVAC 组为 63.3%；p=0.21）无差异。与 GC 相比，HD-MVAC 联合预防性 G-CSF 导致发热性中性粒细胞减少症的发生率更高（p<0.001）。NAC 方案不是 OS 的独立预后因素。
结论
GC 和 HD-MVAC 作为 MIBC/UTUC 的 NAC 时，肿瘤学结局无显著差异。
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