辅助化疗在肌层浸润性膀胱尿路上皮癌中的应用
- Authors
- Jonathan E Rosenberg, MD
Jonathan E Rosenberg, MD
- Associate Attending Physician
- Associate Professor
- Section Head, Non-Prostate Genitourinary Malignancies
- Memorial Sloan-Kettering Cancer Center
- Weill-Cornell Medical College
- Joaquim Bellmunt, MD, PhD
Joaquim Bellmunt, MD, PhD
- Director, Bladder Cancer Center
- Dana-Farber Cancer Institute
- Dana-Farber/Brigham and Women's Cancer Center
- Associate Professor, Harvard Medical School
- Cora N Sternberg, MD, FACP
Cora N Sternberg, MD, FACP
- Chief
- Department of Medical Oncology
- San Camillo and Forlanini Hospitals
- Rome, Italy
- Section Editor
- Derek Raghavan, MD, PhD, FACP, FASCO
Derek Raghavan, MD, PhD, FACP, FASCO
- Section Editor — Bladder Cancer
- President, Levine Cancer Institute
- Carolinas HealthCare System
- Charlotte, NC
- Deputy Editor
- Michael E Ross, MD
Michael E Ross, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology
- Translators
- 付伟金, 副主任医师
付伟金, 副主任医师
- 广西医科大学第一附属医院泌尿外科
引言
膀胱癌是泌尿系统最常见的恶性肿瘤。尿路上皮(移行上皮)癌是膀胱癌的主要组织学类型，特别是在美国和欧洲，占所有膀胱癌的90%。在世界其他地区，非尿路上皮癌相对较多见。 (参见“膀胱尿路上皮(移行细胞)癌的流行病学和危险因素”，关于‘流行病学’一节)
在确定对转移期尿路上皮癌患者的有效化疗方案之后，新辅助化疗和辅助化疗均得以开展。对于局部进展期膀胱癌患者，新辅助化疗具有生存优势[1]，但临床医生还不能识别哪些患者最有可能从治疗中获益，这就导致了有些患者可能会接受过度治疗。因此，许多临床医生和患者选择根治性手术而非新辅助化疗。对于接受一期手术的患者，特别是根据病理学分期认为复发风险很高的患者，术后可以给予辅助治疗。
本文将总结辅助化疗对于局部进展期膀胱尿路上皮癌患者的作用。膀胱癌的手术治疗和新辅助化疗的作用将单独讨论。 (参见“膀胱尿路上皮癌的初始处理和治疗概述”和“Radical cystectomy and bladder-sparing treatments for urothelial bladder cancer”和“肌层浸润性尿路上皮(移行细胞)膀胱癌的新辅助疗法和保留膀胱方案”)
辅助化疗的依据
对于肌层浸润性膀胱癌患者，单纯膀胱切除术的总治愈率一般为50%-65%不等，而病理分期为T2期的患者，治愈率最高可达80%[2]。相比之下，局部进展期患者的结局有可能更差。肿瘤浸润超过膀胱肌层患者的5年生存率约为40%，而存在淋巴结转移患者的5年生存率约为35%。
鉴于新辅助化疗具有获益和手术切除后的患者预后较差，辅助化疗通常用于高危型膀胱癌患者。遗憾的是，约有30%的患者在根治性膀胱切除术后出现并发症，因而无法接受辅助化疗[3]。
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