"新辅助化疗与尿道外切除以保护膀:保留膀的15年随访"
Sherri M Donat1, Amy L Tin2, Andrew J Vickers2
1Urology Service Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
The Journal of urology
|August 6, 2025
概括
选择肌肉侵入性膀癌患者在化疗和尿道切除 (TUR) 后可以实现膀的保存. 长期结果显示,在完整的膀下生存的机会很大,但局部复发需要终身监测.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 癌症研究 癌症研究
背景情况:
- 膀的保存是肌肉侵入性膀癌 (MIBC) 患者的一个关键目标.
- 既定标准确定了理想的候选人,但关于风险和收益的可靠长期数据有限.
- 不同类型的患者队列和短时间的随访复杂化了对膀保护策略的评估.
研究的目的:
- 评估符合膀保存理想标准的MIBC患者的长期结果.
- 评估初始治疗的疗效,包括全身疗法,其次是通过尿道切除 (TUR).
- 在这个精选组中确定膀完整生存率,局部无复发生存率和癌症特异性生存率.
主要方法:
- 对101名前性监测患者的回顾性审查,这些患者符合"理想"的膀保存标准.
- 患者接受了新辅助化疗 (基于Cisplatin) 和TUR.
- 随访时间超过10年,主要终点包括膀完整存活率,局部复发和癌症特异性存活率.
主要成果:
- 膀癌15年死亡风险为11%,与其他原因死亡风险相竞争的44%.
- 大约40%的患者实现了长期的膀保存,11%的患者需要囊切除术.
- 当地复发发生在有完整膀的三分之一的患者中,这表明需要终身监测.
结论:
- 使用新辅助化疗和TUR进行膀保护,对于精心挑选的MIBC患者来说是一个可行的策略.
- 进行膀节约治疗的决定需要仔细考虑长期保存概率与过度死亡率的风险.
- 这些发现凸显了确定的选择标准的重要性以及持续监测复发的必要性.
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