Lerner S E, Blute M L, Richardson R L, Zincke H
Department of Urology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1996 Oct;71(10):945-50.
To report the results of platinum-based chemotherapy used at one medical center in patients with advanced transitional cell carcinomas (TCCs) of the upper urinary tract.
Between July 1981 and February 1993, 28 patients (mean age, 59.3 years) with advanced TCC of the upper urinary tract received cisplatin-based chemotherapy. Of the 28 patients, 14 received a median of 4 cycles of cisplatin, methotrexate, and vinblastine sulfate, 8 received a median of 4.5 cycles of methotrexate, vinblastine, doxorubicin hydrochloride, and cisplatin, 5 received a median of 5 cycles of etoposide and cisplatin, and 1 was treated with 7 cycles of only cisplatin. Overall survival estimates were constructed from nonparametric analysis with the Kaplan-Meier method.
The overall response rate (partial and complete) to chemotherapy was 54%. The most responsive metastatic sites were the lung and lymph nodes-78 and 47% overall response rate, respectively. The estimated median duration of survival for the entire study group was 14 months. In the study population, only three patients were long-term survivors. A significant survival advantage was noted only in the few patients (with limited metastatic tumor volume) who had a complete response to therapy. Initial dose reductions in chemotherapy because of decreased baseline renal function were necessary in 79% of the patients.
Removal of the primary lesion in the presence of metastatic or locally advanced disease does not apparently improve chemotherapy response rates or patient survival. In addition, many patients do not receive optimal dosing of systemic chemotherapy after nephrectomy. Therefore, by avoiding dose modifications, the overall response rates and survival may conceivably be improved. A diagnostic biopsy or nephron-sparing surgical procedure and neoadjuvant systemic therapy may be considered in patients with advanced TCC at the time of initial assessment in order to allow optimal dosing of chemotherapy.
报告一家医疗中心对晚期上尿路移行细胞癌（TCC）患者使用铂类化疗的结果。
1981年7月至1993年2月，28例（平均年龄59.3岁）晚期上尿路TCC患者接受了以顺铂为基础的化疗。28例患者中，14例接受了中位数为4个周期的顺铂、甲氨蝶呤和硫酸长春碱化疗，8例接受了中位数为4.5个周期的甲氨蝶呤、长春碱、盐酸阿霉素和顺铂化疗，5例接受了中位数为5个周期的依托泊苷和顺铂化疗，1例仅接受了7个周期的顺铂治疗。采用Kaplan-Meier方法通过非参数分析构建总生存估计值。
化疗的总缓解率（部分缓解和完全缓解）为54%。反应最明显的转移部位是肺和淋巴结，总体缓解率分别为78%和47%。整个研究组的估计中位生存期为14个月。在研究人群中，只有3例患者为长期存活者。仅在少数对治疗有完全反应（转移肿瘤体积有限）的患者中观察到显著的生存优势。79%的患者因基线肾功能下降而需要在化疗时初始减量。
在存在转移或局部晚期疾病的情况下切除原发灶显然不会提高化疗缓解率或患者生存率。此外，许多患者在肾切除术后未接受最佳剂量的全身化疗。因此，通过避免剂量调整，总体缓解率和生存率可能会得到改善。对于晚期TCC患者，在初始评估时可考虑进行诊断性活检或保留肾单位手术及新辅助全身治疗，以便给予最佳剂量的化疗。
