目的：過去的研究指出M-VAC及GC皆為膀胱泌尿上皮癌標準的第一線化學治療，兩者具有相似的存活期，但GC似乎有較高的安全性與接受度。然而在現行的臨床指引中，並未明確的指出這兩種化學治療在臨床使用上的選擇。本篇研究的目的，主要是想要找出轉移部位與化療效果之間的關連性。
方法：我們回溯性的收集了在我們機構接受治療的轉移性膀胱泌尿上皮癌的患者，並逐一分析患者的臨床資料、無惡化存活期、整體存活期、整體反應率及完全反應率。
結果：在2000年和2012年間，總共有76的患者被納入我們的研究，平均年紀為64.5歲，平均追蹤期為13.6個月。其中，37個患者為僅有淋巴轉移，39個患者為非僅有淋巴轉移。比起非僅有淋巴轉移，膀胱泌尿上皮癌併僅有淋巴轉移患者有較佳的生存預後，無惡化存活期中位數為10.0個月比4.3個月(P=<0.01)，整體存活率中位數為16.9個月比10.5個月(P=<0.01)，客觀反應率及完全反應率也都有顯著性的差異。次群體分析顯示膀胱泌尿上皮癌併僅有淋巴轉移之患者接受M-VAC治療比起接受GC治療有較佳的預後，無惡化存活期中位數為16.4個月比8.7個月(P=<0.01)，整體存活期中位數為23.1個月比16.0個月(P=<0.01)，完全反應率亦達顯著性的差異。
結論：比起非僅有淋巴轉移，膀胱泌尿上皮癌併僅有淋巴轉移的患者有較佳的生存預後及完全反應率，這個效益在接受M-VAC治療的患者身上更為顯著。我們的觀察需要更多前瞻性隨機分派臨床試驗加以確認。

Background: Previous studies demonstrated that GC (gemcitabine and cisplatin) provided asimilar survival advantage as M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin)for urothelial carcinoma of the bladder (UCB), and had a better safety profile and improvedtolerability. However, no clinical clues in selection of first-line chemotherapy regimen weresuggested. This study aims to determine whether different sites of metastasis and chemotherapyregimens affected the prognosis of patients with metastatic UCB.
Methods: Patients with metastatic UCB were retrospectively reviewed. Data on clinical characteristics,progression free survival (PFS), overall survival (OS), overall response rate (ORR)and complete response (CR) rate were analyzed.
Results: Between 2000 and 2012, a total of 76 patients with metastatic UCB were enrolled.The median age was 64.5 years and the median follow-up period was 13.6 months. Of thesepatients, 37 had lymph node-only metastasis (LOM) and 39 had non-LOM. The median survivalwas significantly longer for UCB patients with LOM. The median PFS was 10.0 monthsfor LOM and 4.3 months for non-LOM (P = < 0.01), while the median OS was 16.9 monthsfor LOM and 10.5 months for non-LOM (P = < 0.01). The ORR and CR rate were both significantlyhigher in patients with LOM than in those with non-LOM. Subgroup analysis suggestedthat UCB patients with LOM treated with M-VAC had a better survival. The medianPFS was 16.4 months in the M-VAC group and 8.7 months in the GC group (P = 0.08), whilethe median OS was 23.1 months in the M-VAC group and 16.0 months in the GC group (P =0.03). The CR rate remained significant.
Conclusions: UCB patients with LOM, especially those treated with M-VAC, had better survivaloutcomes and greater CR rate than those with non-LOM. However, the sample size ofthis study was quite small and analyzed on a retrospective basis. Further prospective randomizedstudies are warranted.