在小细胞神经内分泌癌的尿路进展和转移性复发结果
Mohammad Jad Moussa1, Georges C Tabet2, Arlene O Siefker-Radtke1
1Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer medicine
|January 20, 2025
概括
尿路小细胞神经内分泌癌 (SCNEC-URO) 经常在远处复发,包括中枢神经系统 (CNS). 治疗后残留的SCNEC组织学显著增加了复发风险,需要加强监测.
科学领域:
- 尿瘤学 尿瘤学
- 医学瘤学 医学瘤学
- 手术瘤学手术瘤学
背景情况:
- 尿路小细胞神经内分泌癌 (SCNEC-URO) 的预后比常规尿癌 (UC) 更差.
- 在SCNEC-URO手术后的预测因素和复发模式需要进一步调查.
研究的目的:
- 为了评估SCNEC-URO患者的复发预测因素,他们接受了确定的手术治疗.
- 描述SCNEC-URO的手术管理后复发的模式和时间.
主要方法:
- 确定了一组224名SCNEC-URO (cT1-T4NxM0) 患者的队列,他们在1985-2021年期间接受了绝对手术治疗.
- 审查了组织病理学,并使用竞争性风险方法 (累积发病率函数) 估计了复发概率.
- 用细灰色分布模型来评估与复发的共同变量关联.
主要成果:
- 大多数患者 (71.9%) 接受了新辅助化疗. 总体而言,41%的患者复发,83.7%患有远程转移,其中10.9%患有专属中枢神经系统 (CNS) 转移,主要是在一年内.
- 新辅助化疗后的病理完整反应 (pCR) 与5年复发风险 (16.5%) 最低相关.
- 切除时任何残留的SCNEC组织学,无论新辅助化疗,显著增加复发风险 (HR=3.69,p=0.0001).
结论:
- SCNEC-URO是一种全身性疾病,对远程复发的倾向很高,包括中枢神经系统的参与.
- 切除时的组织学是影响复发风险的关键因素,与新辅助化疗和癌症阶段一起.
- 这些发现支持对新型新辅助/辅助疗法的需求,并建议对高风险患者在手术后的第一年内对中枢神经系统进行监测.
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