吉西他滨联合顺铂三周方案治疗复发和转移性膀胱癌的临床观察

目的评价吉西他滨联合顺铂三周方案治疗复发和转移性膀胱癌的疗效和安全性。方法GC组25例,吉西他滨1000mg/m2,静脉滴注,第1、8天;顺铂25mg/m2,静脉滴注,第1～3天,21d为1周期。MVAC组24例,甲氨蝶呤30mg/m2,静脉滴注,第1、15、22天;长春花碱3mg/m2,静脉滴注,第2、15、22天;阿霉素30mg/m2,静脉滴注,第2天;顺铂25mg/m2,静脉滴注,第1～3天,28d为1周期。至少化疗4个周期。结果GC组CR3例（12.0%）,PR9例（36.0%）,总有效率为48.0%。其中,初治组18例中CR2例（11.1%）,PR7例（38.9%）,有效率为50.0%;复治组7例中CR1例（14.3%）,PR2例（28.6%）,有效率为42.9%。MVAC组CR2例（8.3%）,PR8例（33.3%）,总有效率为41.7%。其中,初治组16例中CR2例（12.5%）,PR6例（37.5%）,有效率为50.0%;复治组8例中无CR,PR2例,有效率为25.0%。两组比较差异无统计学意义（χ2=0.199,P=0.656）。GC组1,2年生存率分别为76.0%和16.0%;MVAC组1,2年生存率分别为75.0%和8.3%。GC、MVAC组中位生存期分别为16个月（95%CI13.55～18.45）和16个月（95%CI14.11～17.89）。Ⅲ/Ⅳ度血小板减少症、皮疹、疲乏GC组高于MVAC组;Ⅲ/Ⅳ度中性粒细胞减少、中性粒细胞减少性发热,恶心、呕吐等毒副反应MVAC组高于GC组,两组比较差异无显著性（P〉0.05）。结论吉西他滨联合顺铂三周方案化疗治疗复发和转移性膀胱癌具有与标准MVAC方案相似的疗效,且更安全。

Clinical observation of gemcitabine and cisplatin three-week regimen in the treatment of recurrent or metastatic bladder cancer

Objective To evaluate the efficacy and satety of gemcitabine and cisplatin three-week regimen in the treatment of recurrent or metastatic bladder cancer. Methods Forty-nine cases of recurrent or metastatic bladder cancer were randomly divided into 2 groups： the GC group： 25 cases, gemcitabine 1000 mg/m2, intravenous infusion on days 1 and 8, cisplatin 25 mg/m2 , intravenous infusion on first 1-3 days, 21 days constituted a course of treatment ; the MVAC group ： 24 cases, methotrexate 30 mg/m2 , intravenous infusion on days 1,15,22, vinblastine 3 mg/m2, intravenous infusion on days 2,15,22, doxorubicin 30 mg/m2, intravenous infusion on day 2, cisplatin 25 mg/m2, intravenous infusion on days 1-3, 28 days constituted a course of treatment. At least four courses of chemotherapy were given. Results GC group ： CR 3 cases （12. 0% ） , PR 9 cases （36. 0% ） , total effective rate was 48.0%. In this group, of 18 previously untreated patients, 2 got CR （ 11.1% ）, 7 PR （38.9%）, with effechtive rate orS0. 0%. Of 7 retreated patients, 1 got CR（14. 2% ）, 2 PR（28. 6% ）, with effective rate of 42.9 %. MVAC group： CR 2 patients （8. 3% ）, PR 8 cases （33.3%） , total effective rate was 41.7%. In this group, of 16 previously untreated patients, 2 got CR（ 12. 5% ）, 6 PR（37.5% ）, with effective rate of 50. 0%. Of 8 retreated cases no CR, 2 PR（25.0% ）, with effective rate of 25.0 %. Comparing the two groups, the difference was not significant （~z = 0. 199, P = 0. 656）. In GC group, 1,2-year survival rates were 76.0% and 16. 0% respectively; 1,2-year survival rates of MVAC group were 75.0% and 8.3% respectively. The median survival time in GC and MVAC groups was 16 months （95% CI 13.55-18.45） and 16 months （95% CI 14. 11-17. 89）. Incidences of Ⅲ/Ⅳdegree of thromboeytopenia, rash, fatigue were higher in GC group than in MVAC group. Incidences of toxic reactions such as Ⅲ/Ⅳ degree of neutropenia, neutropenic fever,nausea and vomiting were higher in MVAC group than in G