研究背景：本篇回溯性研究的主要目的，為探討分析手術後輔助性化學治療對於侵襲性上泌尿道移形上皮細胞癌的療效，以利將來做為選取病人接受此輔助性化學性治療之參考。
研究方法: 從1988年至1996年，有65個病人因侵襲性上泌尿道移形上皮細胞癌，至同一醫療院所接受根除性手術，其中有58個病人可提供完整病歷記錄及病理資料者，進入此研究。這58個病人，其中15個病人手術後病理標本，呈現淋巴結癌症陽性反應，43個病人則為陰性反應。58個病人當中，有36個病人同意並接受了術後輔助性化學治療。統計分析方法為Cox proportional 風險模式，用來比較許多臨床及病理特徵對於病人存活率的影響。將有意義的影響因子，用Kaplan-Meier及log-rank 檢定方法分析其無疾病(disease-free)存活率及全部(overall)存活率是否會因輔助性化學治療而有差別。
結果:在此篇研究當中，病患手術後到接受化學治療的時間之中位數(median)為5.6週，範圍為3至13週。追蹤時間的中位數是36個月，範圍是2至105個月。三年的無疾病(disease-free)和全部(overall)存活率分別為59%和64％。在多變數分析中，只有淋巴結狀態為有意義的影嚮因子。本研究在15個淋巴結癌症陽性病人的子群分析當中，其中9個接受術後輔助性化學治療者，其三年的無疾病(disease-free)存活率優於未接受化學治療者( p值＝0.0424.)，而三年全部(overall)存活率也有改善，但無統計學上的意義(p值＝0.0729)。
結論:這些研究結果顯示，淋巴結狀態會影響侵襲性上泌尿道移形上皮細胞癌病人的預後，而且術後輔助性的化學治療可改善淋巴結癌症陽性病人無疾病(disease-free)存活率。基於此結果，我們可以選擇淋巴結侵犯的病人建議其接受術後輔助性化學治療，藉此延長病人的存活率，及降低癌症死亡率。
Background: The objective of this study was retrospectively investigate the effectiveness of adjuvant methotrexate, epirubicin, and cisplatin(MEC) combination chemotherapy for invasive transitional cell carcinoma of the upper urinary tract.
Methods: Between 1988 and 1996, 65 patients diagnosed with invasive transitional cell carcinoma of the upper urinary tract underwent radical operation at one institution. There were 58 patients that could be analyzed from the medical records were enrolled in this study. Fifteen patients had lymph node –positive disease and 43 patients did not. Thirty-six patients at high risk for recurrence received MEC chemotherapy and 22 patients were observed after surgery. Cox proportional hazards models were used to determine the impact of numerous clinicopathological findings on survival. A subgroup analysis of patients with lymph node-positive disease was conducted to evaluate disease-free survival and overall survival rates.
Results: In this series, the median interval between operation and chemotherapy was 5.6 weeks (range, 3-13) , the median follow-up period was 36 months (range, 2-105 ) after surgery. Disease-free and overall survival rates were 59% and 64%, respectively, at 3 years. Only lymph node status was significantly associated with disease-free and overall survival in multivariate analysis. In a subgroup analysis of patients with lymph node-positive, 9 patients who underwent adjuvant chemotherapy had superior disease-free survival compared to 6 patients with no adjuvant chemotherapy (p=0.0424).
Conclusion: These finding showed that the prognosis of invasive transitional cell carcinoma of the upper urinary tract is significantly associated with nodal status. Adjuvant MEC chemotherapy is feasible and has a positive impact on survival in patients with lymph node-positive disease. Base on this, we can select patients with nodal involvement for adjuvant chemotherapy which may extend the median survival and reduce the rate of cancer death.
