尽量减少过度治疗,最大限度地提高上道泌尿器官癌的瘤结果
Ali H Zahalka1, Vitaly Margulis
1Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA.
Current opinion in urology
|December 4, 2024
概括
新的上道泌尿道癌 (UTUC) 治疗提供了更好的结果,但存在过度治疗的风险. 新兴技术有望提高UTUC患者治疗反应的分级,分期和监测的准确性.
科学领域:
- 尿瘤学 尿瘤学
- 新生病是什么?新生病新生病是什么?
- 泌尿生殖系统病理学
背景情况:
- 上管泌尿道癌 (UTUC) 的管理需要平衡瘤结果与过度治疗风险.
- 精确的分级和分阶段是至关重要的,但具有挑战性,可能导致低于最佳的治疗策略.
研究的目的:
- 审查工会统一管理的最新进展.
- 强调优化瘤结果的策略,同时尽量减少过度治疗.
主要方法:
- 审查最近的高质量的临床试验和新兴的诊断/治疗技术.
- 对各种UTUC阶段的治疗疗效和副作用概况的分析.
主要成果:
- 如3D组织学和无细胞瘤DNA等新兴工具可能会提高诊断准确性和治疗监测.
- 新型疗法显示出低度UTUC复发减少的潜力,但具有副作用.
- 新辅助化疗在高等级的UTUC中表现有前途,尽管预测反应者很困难.
- 辅助化疗改善了生存率,但免疫疗法的益处尚不清楚,这表明可能存在过度治疗.
- 向疗法推进转移性UTUC治疗,但具有较高的不良事件率.
结论:
- 低等级的UTUC由于其低转移潜力而容易过度处理.
- 高度和高级的UTUC需要积极的治疗,但不准确的分期使新辅助策略复杂化.
- 预计未来的技术将提高诊断精度,并使UTUC治疗反应的非侵入性监测成为可能.
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