요로상피세포암종 환자에서 수술전 보조항암화학요법으로 Gemcitabine-Cisplatin 치료와 dose-dense MVAC 을 시행받은 환자의 치료성적 비교분석

Abstract

Background Prospective randomized trials demonstrated efficacy of MVAC (Methotrexate, Vinblastine, Doxorubicin, Cisplatin) neoadjuvant chemotherapy (NAC) in muscle invasive bladder cancer (MIBC). In metastatic setting urothelial cell carcinoma (UCC), clinical trials showed no difference in oncologic outcomes between Gemcitabine-Cisplatin (GC) and MVAC, and another prospective trial proved dose-dense (dd) MVAC had significantly better overall survival (OS) and response rate then MVAC. Comparative data between GC and ddMVAC are limited in neoadjuvant setting. Methods A retrospective analysis of patients with urothelial carcinoma (cT2-4aN0-1M0) who received NAC from January 2011 and December 2017 in Asan Medical Center was conducted. Patients who received GC were compared to patients received ddMVAC in terms of outcomes including downstaging (Results In a total of 277 patients, 176 patients received NAC with GC and 41 patients with dose-dense MVAC. The median chemotherapy cycle is 4 (IQR 3-4) cycles for GC group, 4 (IQR 3-5.5) cycles for dose-dense MVAC group. With an exception of age; GC group is associated with younger age (p=0.002), other baseline characteristics are well balanced between groups. Downstaging rate are 50.8% in GC group, 58.1% in dose-dense MVAC group (p=0.47). The rates of achieving ypT0 (28.7% vs 22.6%, p=0.68), ypN0 (78.3% vs 81.5%, p=0.39). There were no differences in overall survival (OS) at 3 year (72.2% vs 73.2%, p=0.58), disease-free survival (DFS) at 3 years (54.9% vs 63.3%, p=0.21) according to chemotherapy regimens. ddMVAC with prophylactic G-CSF are associated with higher incidence of febrile neutropenia (p=0.004) than GC. NAC regimen is not independent prognostic factor for OS on multivariable analysis. Conclusions GC regimen had no significant difference in oncologic outcomes compare to ddMVAC as NAC in UCC.