吉西他滨联合奥沙利铂双周方案治疗尿路上皮癌的可行性分析

目的：初步评价吉西他滨联合奥沙利铂（GEMOX）双周方案治疗尿路上皮癌的疗效和安全性。方法选取20例浸润性或转移性尿路上皮癌患者，患者均为男性，中位年龄62岁，其中6例超过70岁，7例接受过单侧肾切除术；辅助化疗6例，一线化疗14例。给予吉西他滨1000 mg/m2静脉滴注d1，奥沙利铂85 mg/m2静脉滴注d2；每2周为一个周期。评价患者近期疗效及不良反应，同时观察无进展生存期（PFS）或者无病生存期（DFS）以及总生存期（OS）。结果全部患者共接受GEMOX方案化疗106周期，中位化疗5周期。14例一线化疗患者中位随访24个月，12例死亡，中位PFS为5个月，中位OS为14个月；10例患者可评价客观疗效，PR 4例（40%），SD 4例（40%），PD 2例（20%）。6例辅助化疗患者中位随访51个月，1例复发死亡，5例无病生存，尚未到达中位DFS和OS。消化道反应和骨髓抑制是最常见的不良反应，中性粒细胞下降（15.8%）是最常见3~4级不良反应。结论GEMOX方案治疗尿路上皮癌耐受良好，在一线化疗中展现了较好的疗效，值得在老年患者或具有肾功能不全高危风险的患者中进一步研究。

The feasibility of biweekly gemcitabine combined with oxaliplatin in urothelial carcinoma

Objective To assess the efficacy and safety of biweekly regimen of gemcitabine combined with oxaliplat-in (GEMOX regimen) in urothelial carcinoma. Method 20 patients with invasive or metastatic urothelial carcinoma were enrolled in this study. All patients were male, with a median age of 62 years, 6 of them were over 70 years, and 7 pa-tients underwent unilateral nephrectomy; 6 patients had adjuvant chemotherapy, while 14 patients received GEMOX as first-line chemotherapy. GEMOX regimen: gemcitabine 1000 mg/m2 ivgtt, d1, oxaliplatin 85 mg/m2 ivgtt, d2, with 2 weeks as a cycle. Short-term response rate and adverse reactions were observed, and progression-free survival (PFS), dis-ease-free survival (DFS) and overall survival (OS) were also evaluated. Result A total of 106 cycles were completed, and the median number of cycles was 5. Patients who were given first-line chemotherapy had a median follow-up of 24 months, in which there were 12 cases of death, with a median PFS of 5 months, and the median OS was 14 months;Among the 10 evaluable cases, partial response (PR) was observed in 4 (40%), stable disease (SD) in 4 (40%), and pro-gression disease (PD) in 2 (20%). The median follow-up time was 51 months in adjuvant therapy group. One patient died of recurrence, 5 patients survived without disease, while the mPFS and the mOS were not reached. Digestive reactions and myelosuppression were the most common toxicities. Neutropenia (15.8%) was the most frequent adverse reaction of grade 3~4. Conclusion GEMOX showed an encouraging efficacy and a good safety profile as first-line chemotherapy in urothelial carcinoma, which merits further investigation in patients with urothelial carcinoma, especially in geriatric pa-tients or patients with high risk of renal dysfunction.