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題名 | Metastatic Urothelial Carcinoma of the Bladder with Lymph Node-only Metastasis Treated with M-VAC (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) Has a Better Survival than GC (Gemcitabine and Cisplatin)=轉移性膀胱泌尿上皮癌僅有淋巴轉移的患者接受M-VAC治療有較佳的預後 |
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作者 | 謝孟哲; 江博暉; 饒坤銘; 陳彥仰; 蘇祐立; 黃承華; Hsieh, Meng-che; Chiang, Po-hui; Rau, Kun-ming; Chen, Yen-yang; Su, Yo-li; Huang, Cheng-hua; |
期刊 | 臺灣癌症醫學雜誌 |
出版日期 | 20141200 |
卷期 | 1:3 2014.12[民103.12] |
頁次 | 頁197-207 |
分類號 | 416.27 |
語文 | eng |
關鍵詞 | 膀胱泌尿上皮癌; 僅有淋巴轉移; M-VAC化學治療; GC化學治療; 生存預後; 反應率; Urothelial carcinoma of the bladder; Lymph node-only metastasis; M-VAC; GC; Survival benefits; Response rate; |
中文摘要 | 目的:過去的研究指出 M-VAC 及 GC 皆為膀胱泌尿上皮癌標準的第一線化學治療,兩者 具有相似的存活期,但 GC 似乎有較高的安全性與接受度。然而在現行的臨床指引中,並 未明確的指出這兩種化學治療在臨床使用上的選擇。本篇研究的目的,主要是想要找出 轉移部位與化療效果之間的關連性。 方法:我們回溯性的收集了在我們機構接受治療的轉移性膀胱泌尿上皮癌的患者,並逐 一分析患者的臨床資料、無惡化存活期、整體存活期、整體反應率及完全反應率。 結果:在 2000 年和 2012 年間,總共有 76 的患者被納入我們的研究,平均年紀為 64.5 歲, 平均追蹤期為 13.6 個月。其中,37 個患者為僅有淋巴轉移,39 個患者為非僅有淋巴轉移。 比起非僅有淋巴轉移,膀胱泌尿上皮癌併僅有淋巴轉移患者有較佳的生存預後,無惡化 存活期中位數為 10.0 個月比 4.3 個月 (P = < 0.01),整體存活率中位數為 16.9 個月比 10.5 個月 (P = < 0.01),客觀反應率及完全反應率也都有顯著性的差異。次群體分析顯示膀胱 泌尿上皮癌併僅有淋巴轉移之患者接受 M-VAC 治療比起接受 GC 治療有較佳的預後,無 惡化存活期中位數為 16.4 個月比 8.7 個月 (P = < 0.01),整體存活期中位數為 23.1 個月比 16.0 個月 (P = < 0.01),完全反應率亦達顯著性的差異。 結論:比起非僅有淋巴轉移,膀胱泌尿上皮癌併僅有淋巴轉移的患者有較佳的生存預後 及完全反應率,這個效益在接受 M-VAC 治療的患者身上更為顯著。我們的觀察需要更多 前瞻性隨機分派臨床試驗加以確認。 |
英文摘要 | Background: Previous studies demonstrated that GC (gemcitabine and cisplatin) provided a similar survival advantage as M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for urothelial carcinoma of the bladder (UCB), and had a better safety profile and improved tolerability. However, no clinical clues in selection of first-line chemotherapy regimen were suggested. This study aims to determine whether different sites of metastasis and chemotherapy regimens affected the prognosis of patients with metastatic UCB. Methods: Patients with metastatic UCB were retrospectively reviewed. Data on clinical characteristics, progression free survival (PFS), overall survival (OS), overall response rate (ORR) and complete response (CR) rate were analyzed. Results: Between 2000 and 2012, a total of 76 patients with metastatic UCB were enrolled. The median age was 64.5 years and the median follow-up period was 13.6 months. Of these patients, 37 had lymph node-only metastasis (LOM) and 39 had non-LOM. The median survival was significantly longer for UCB patients with LOM. The median PFS was 10.0 months for LOM and 4.3 months for non-LOM (P = < 0.01), while the median OS was 16.9 months for LOM and 10.5 months for non-LOM (P = < 0.01). The ORR and CR rate were both significantly higher in patients with LOM than in those with non-LOM. Subgroup analysis suggested that UCB patients with LOM treated with M-VAC had a better survival. The median PFS was 16.4 months in the M-VAC group and 8.7 months in the GC group (P = 0.08), while the median OS was 23.1 months in the M-VAC group and 16.0 months in the GC group (P = 0.03). The CR rate remained significant. Conclusions: UCB patients with LOM, especially those treated with M-VAC, had better survival outcomes and greater CR rate than those with non-LOM. However, the sample size of this study was quite small and analyzed on a retrospective basis. Further prospective randomized studies are warranted. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。