根性瘤切除术前的新辅助化疗:根据病理结节状态的生存结果和复发模式
Farshad Sheybaee Moghaddam1, Rashid K Sayyid1, Alireza Ghoreifi1
1Norris Comprehensive Cancer Center, Department of Urology, University of Southern California, Los Angeles, CA.
Urologic oncology
|March 25, 2025
概括
在手术前的新辅助化疗 (NAC) 恶化了上道尿路细胞癌 (UTUC) 患者的生存结果,这些患者具有阳性淋巴结 (ypN+). 复发模式也根据节点和NAC状态显著不同.
科学领域:
- 尿道瘤学 尿道瘤学
- 医学瘤学 医学瘤学
- 手术瘤学手术瘤学
背景情况:
- 上道泌尿道癌 (UTUC) 是一种罕见的恶性瘤.
- 新辅助化疗 (NAC) 越来越多地用于UTUC在激进脏切除术 (RNU) 和淋巴结解剖 (LND) 之前.
- 基于病理结节状况的NAC对生存和复发模式的影响还不清楚.
研究的目的:
- 评估在RNU+LND之前接受NAC的UTUC患者的生存结果.
- 在NAC和手术后,根据病理结节状态 (pN+与ypN+) 分析复发模式.
- 为了比较节点阴性 (pN0/ypN0) 和节点阳性 (pN+/ypN+) UTUC患者之间的结果.
主要方法:
- 从ROBUUST 2.0数据库中对883名UTUC患者进行了回顾性分析.
- 患者接受了机器人/腹腔镜RNU+LND,有或没有NAC.
- 分为pN0,ypN0,pN+和ypN+子组的分层;使用卡普兰-梅尔曲线和考克斯回归的生存分析.
主要成果:
- 15%的患者接受了NAC;24%的患者有阳性节点 (ypN+).
- 与pN+患者相比,ypN+患者在1,3年和5年内整体存活率 (OS) 显著降低.
- ypN+患者的结节/区域或远程转移发病率较高,作为最初的复发地点 (89%与pN+的39%相比).
结论:
- ypN+ UTUC 患者的生存结果比 pN+ 患者差.
- 复发模式根据NAC的管理和节点状态有显著差异.
- 这些发现对工人联合会管理中的监测和治疗策略有影响.
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