Department of Hematology and Oncology, Division of Internal Medicine, University of Michigan, C351 Med Inn, SPC 5848, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
Nat Rev Urol. 2012 Apr 10;9(5):266-73. doi: 10.1038/nrurol.2012.57.
Upper tract urothelial cancer (UTUC) is an aggressive disease associated with significant morbidity and mortality. Radical nephroureterectomy (RNU) with bladder cuff removal is considered the standard of care for most invasive UTUCs but distant relapses after surgery for locally advanced, high-grade disease are common. Although multimodality treatment with perioperative chemotherapy has been investigated thoroughly in recent years, adjuvant chemotherapy has primarily been analyzed in small retrospective uncontrolled studies and a clear benefit for this treatment modality is yet to be established. It is likely that the high incidence of renal insufficiency after surgery substantially limits the applicability of adjuvant chemotherapy with cisplatin-based regimens. Neoadjuvant cisplatin-based chemotherapy has several practical advantages over adjuvant therapy, including better patient tolerance in the preoperative setting when a patient has two kidneys rather than one and the obtainment of prognostic information from pathological downstaging. Although, some academic centers have adopted neoadjuvant chemotherapy as a de facto treatment standard for patients with high-grade locally advanced UTUC, this treatment approach has not been prospectively validated or adopted in general urologic practice. A multicenter trial of neoadjuvant chemotherapy for locally advanced high-grade UTUC could further define the role of neoadjuvant chemotherapy in treating UTUC.
上尿路尿路上皮癌（UTUC）是一种侵袭性疾病，与较高的发病率和死亡率相关。根治性肾输尿管切除术（RNU）联合膀胱袖状切除术被认为是大多数侵袭性 UTUC 的标准治疗方法，但对于局部晚期、高级别疾病，手术后远处复发较为常见。尽管近年来已对围手术期化疗的多模式治疗进行了深入研究，但辅助化疗主要在小型回顾性非对照研究中进行分析，这种治疗方式的明确获益尚未得到证实。很可能是由于手术后肾功能不全的高发率，极大地限制了基于顺铂的辅助化疗方案的适用性。新辅助顺铂化疗相对于辅助治疗具有几个实际优势，包括在术前时患者有两个肾脏而非一个肾脏时更好的患者耐受性，以及通过病理降期获得预后信息。尽管一些学术中心已将新辅助化疗作为局部晚期高级别 UTUC 患者的事实上的治疗标准，但这种治疗方法尚未在一般泌尿科实践中得到前瞻性验证或采用。局部晚期高级别 UTUC 的新辅助化疗多中心试验可以进一步明确新辅助化疗在治疗 UTUC 中的作用。
