Stöckle M, Wellek S, Meyenburg W, Voges G E, Fischer U, Gertenbach U, Thüroff J W, Huber C, Hohenfellner R
Department of Urology, University of Mainz Medical School, Germany.
Urology. 1996 Dec;48(6):868-75. doi: 10.1016/s0090-4295(96)00299-3.
To analyze the effectiveness of adjuvant polychemotherapy after radical cystectomy for non-organ-confined transitional cell bladder cancer (Stages pT3b, pT4a, and/or pN1 or pN2).
Of 166 consecutive patients undergoing cystectomy at two institutions from 1987 to 1993, 80 received adjuvant polychemotherapy with methotrexate, vinblastine, and cisplatin plus doxorubicin (MVAC) or epirubicin (MVEC), whereas 86 had cystectomy only. The patients were evaluated for relapse-free survival and length of progression-free interval on the basis of follow-up data obtained in 1995 and 1996.
Kaplan-Meier analysis revealed a significantly higher progression-free rate for patients after adjuvant chemotherapy (P = 0.0002, log-rank test). With and without adjuvant chemotherapy, prognosis declined in a stepwise manner, depending on the extent of lymph node involvement. Nevertheless, the superior prognosis of the chemotherapy group could be demonstrated at each lymph node stage. Of the 166 patients, 49 had initially entered a prospective trial comparing adjuvant with no adjuvant treatment. That study was discontinued in December 1990 after an interim analysis revealed a significant prognostic advantage in favor of the 26 patients randomized to receive chemotherapy compared with the 23 control patients. Current follow-up data continue to demonstrate a significant improvement in progression-free survival in favor of patients randomized to receive adjuvant chemotherapy (P = 0.0040). The follow-up period of patients living free of disease ranges from 58 to 96 months.
Adjuvant chemotherapy with MVAC/MVEC leads to significant prolongation of relapse-free survival and improvement of the definitive cure rate after radical cystectomy for locally advanced transitional cell carcinoma of the urinary bladder.
分析根治性膀胱切除术后辅助性多药化疗对非器官局限性移行细胞膀胱癌（pT3b、pT4a期和/或pN1或pN2期）的疗效。
1987年至1993年期间，在两家机构连续接受膀胱切除术的166例患者中，80例接受了甲氨蝶呤、长春碱、顺铂加阿霉素（MVAC）或表柔比星（MVEC）的辅助性多药化疗，而86例仅接受了膀胱切除术。根据1995年和1996年获得的随访数据，对患者的无复发生存率和无进展间期长度进行评估。
Kaplan-Meier分析显示，辅助化疗后患者的无进展率显著更高（P = 0.0002，对数秩检验）。无论有无辅助化疗，预后均根据淋巴结受累程度呈逐步下降趋势。然而，化疗组在每个淋巴结分期均显示出较好的预后。在这166例患者中，49例最初参加了一项比较辅助治疗与非辅助治疗的前瞻性试验。1990年12月，一项中期分析显示，与23例对照患者相比，随机接受化疗的26例患者具有显著的预后优势，该研究随后停止。目前的随访数据继续显示，随机接受辅助化疗的患者无进展生存期有显著改善（P = 0.0040）。无病生存患者的随访期为58至96个月。
对于局部晚期膀胱移行细胞癌，根治性膀胱切除术后采用MVAC/MVEC辅助化疗可显著延长无复发生存期并提高根治率。
