Wei C H, Hsieh R K, Chiou T J, Chen K K, Chang L S, Chen P M
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
J Urol. 1996 Jan;155(1):118-21.
The feasibility of adjuvant cisplatin, methotrexate and vinblastine chemotherapy was evaluated in Taiwanese patients with invasive transitional cell carcinoma at high risk for recurrence.
We assigned 56 patients with high risk transitional cell carcinoma (vascular or lymphatic invasion in the primary tumor, poorly differentiated stage P2, P3, P4 or N+ and M0) to receive adjuvant chemotherapy after radical urological surgery. The chemotherapy consisted of 40 mg./m.2 methotrexate and 4 mg./m.2 vinblastine on days 1 and 8, and 100 mg./m.2 cisplatin on day 2 given in 6 courses at 21-day intervals.
Median followup was 44 months. An average of 4.63 cycles of chemotherapy was administered. The median actual survival was 44 months, and the 1 and 3-year survival probabilities were 92% and 50%, respectively. The median disease-free survival was 15.5 months, and the 1 and 3-year disease-free survival probabilities were 66% and 28%, respectively. Only 5 (9%) and 1 (2%) patients had grades 3 and 4 leukopenia, respectively, and none died of sepsis.
The use of adjuvant cisplatin, methotrexate and vinblastine chemotherapy in patients with invasive transitional cell carcinoma at high risk for recurrence is feasible with tolerable toxicity but randomized controlled trials will be required to assess the benefit.
评估顺铂、甲氨蝶呤和长春碱辅助化疗在台湾复发高危浸润性移行细胞癌患者中的可行性。
我们将56例高危移行细胞癌患者（原发肿瘤有血管或淋巴浸润、低分化P2、P3、P4期或N+和M0）分配至接受根治性泌尿外科手术后进行辅助化疗。化疗方案为第1天和第8天给予40mg/m²甲氨蝶呤和4mg/m²长春碱，第2天给予100mg/m²顺铂，每21天为一个疗程，共6个疗程。
中位随访时间为44个月。平均给予4.63个化疗周期。中位实际生存期为44个月，1年和3年生存率分别为92%和50%。中位无病生存期为15.5个月，1年和3年无病生存率分别为66%和28%。仅5例（9%）和1例（2%）患者分别出现3级和4级白细胞减少，无患者死于败血症。
对于复发高危浸润性移行细胞癌患者，使用顺铂、甲氨蝶呤和长春碱辅助化疗是可行的，毒性可耐受，但需要进行随机对照试验来评估其益处。
