摘要目的 探讨晚期膀胱尿路上皮癌的临床特点、治疗方法和预后.方法 回顾性分析1998年8月至2009年12月间中国医学科学院肿瘤医院收治的117例晚期膀胱尿路上皮癌患者的临床资料,所有患者均接受一线化疗,46例者接受二线化疗.结果 全组患者的中位年龄为56岁,男女之比为3.33:1.全组患者的半年、1年、2年、3年和5年生存率分别为90.3％、61.3％、32.3％、24.2％和8.1％.一线化疗方案中,吉西他滨+铂类化疗的有效率为49.3％ (37/75),中位无进展生存时间(PFS)和总生存时间(OS)分别为7.9和18.7个月;环磷酰胺+表阿霉素+铂类化疗的有效率为45.5％(10/22),中位PFS和OS分别为7.1和15.3个月;紫杉醇+铂类化疗的有效率为47.1％(8/17),中位PFS和OS分别为6.5和13.7个月.其中吉西他滨+顺铂化疗67例,有效率为47.8％,中位PFS和OS分别为7.0和15.3个月;紫杉醇+卡铂化疗13例,有效率为53.8％,中位PFS和OS分别为7.7和16.0个月.化疗的不良反应主要为中性粒细胞减少和血小板减少等,主要为1～2级,患者可以耐受.结论 吉西他滨+顺铂方案为晚期膀胱尿路上皮癌首选的一线化疗方案之一,其有效率较高,不良反应患者可以耐受.紫杉类药物和分子靶向药物的应用有可能进一步提高晚期膀胱尿路上皮癌的治疗效果.

abstractsObjective The aim of this study was to analyze the clinical characteristics,treatment and prognosis of advanced urothelial carcinoma of the bladder (AUCB).Methods The clinicopathological data of 117 patients with AUCB admitted in our hospital from 1998 to 2009 were reviewed.All patients received first-line chemotherapy.The survival rate was calculated by Kaplan-Meier analysis and log-rank test.Results The median age of all patients was 56 years and the male-to-female ratio was 3.33:1.Their 6-,12-,24-,36-and 60-month survival rates were 90.3％,61.3％,32.3％,24.2％ and 8.1％,respectively.In the first-line chemotherapy regimen,the effectiveness rate of gemcitabine + platinum drugs was 49.3 ％ (37/75),the median progression-free survival (PFS) was 7.9 months and overall survival (OS) was 18.7 months.The effectiveness of cyclophosphamide + epirubicin + platinum drug regimen was 45.5％ (10/22),Median PFS was 7.1 months and OS was 15.3 months.The effectiveness of paclitaxel + platinum drug regimen was 47.1％ (8/17),median PFS was 6.5 months and OS was 13.7 months.Among them,the effectiveness rate of the gemcitabine + cisplatin regimen in 67 patients was 47.8％,the median PFS was 7.0 months and OS was 15.3 months.In the 13 patients who received paclitaxel + carboplatin regimen,the effectiveness rate was 53.8％,median PFS was 7.7 months and OS was 16.0 months.The major side effects were leucopenia and thrombocytopenia,mostly were tolerable,of grade Ⅰ to Ⅱ.Conclusions In advanced unresectable and metastatic urothelial carcinoma of the bladder,GC regimen is recognized as a standard first-line chemotherapy,with a higher effectiveness and tolerable side effects.Taxane and molecular targeted drugs may further improve the therapeutic effect of the treatment of advanced urothelial carcinomas of the bladder in the future.