超越刀:为细胞还原性切除术进行战略性患者选择
Stephan Brönimann1,2, Yasser Ged3, Nirmish Singla3,2
1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Current opinion in urology
|January 19, 2024
概括
转移性细胞癌 (mRCC) 的细胞还原性切除术 (CN) 在低风险患者中显示出有限的益处,但可能有助于选择高风险个体. 在不断变化的治疗环境中,个性化,多学科的决策对于最佳的患者选择至关重要.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
背景情况:
- 转移性细胞癌 (mRCC) 治疗已经通过向疗法和免疫检查点抑制剂进化.
- 细胞还原性切除术 (CN) 历来一直是对mRCC的治疗选择.
- 对CN的患者选择仍然是mRCC管理的关键方面.
研究的目的:
- 评估细胞减轻性切除术 (CN) 在转移性细胞癌 (mRCC) 中的当前作用.
- 评估在不断变化的治疗范式中对患者选择的CN影响.
- 审查向治疗和免疫检查点抑制剂对CN决策的影响.
主要方法:
- 随机试验和对mRCC中CN的回顾性数据的审查.
- 对CN资格的当前风险分层工具的分析.
- 在免疫检查点抑制剂 (ICI) 背景下对CN新兴数据的评估.
主要成果:
- 两项随机试验没有显示CN对接受向治疗的中级/低风险患者有显著益处.
- 亚组分析和回顾性数据表明,对选择的良好/中等风险患者有潜在的益处.
- 目前的CN风险分层工具存在局限性;根据系统性治疗反应,推迟或预先的CN可能是有益的.
结论:
- 在mRCC中,CN的作用和时间已经演变,在一小部分患者中仍然发挥着作用.
- 在多学科讨论中,CN决策需要个性化,考虑患者和瘤因素.
- 需要进一步的前性试验来澄清CN的作用,特别是在免疫检查点抑制剂时代.
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