泌尿外科肿瘤转移的外科治疗。
Surgical resection of urological tumor metastases following medical treatment.
机构信息
Department of Urology, University Hospital Aachen.
出版信息
Dtsch Arztebl Int. 2012 Sep;109(39):631-7. doi: 10.3238/arztebl.2012.0631. Epub 2012 Sep 28.
BACKGROUND
The rate of systemic metastases is about 20% in testicular germ cell tumors, 25% to 30% in prostate cancer, 30% in urothelial carcinoma with muscle invasion, and 50% in renal-cell carcinoma. This article is a critical review of current data on the resection of metastases of urological tumors after systemic drug treatment.
METHODS
Review of pertinent publications retrieved by a selective literature search.
RESULTS
No pertinent prospective, randomized trials, meta-analyses, or Cochrane reviews have been published. The publications available for review include guidelines and retrospective studies with evidence levels ranging from IIB to III. For non-seminomatous germ cell tumors with tumor markers that are negative or have reached a plateau after chemotherapy, resection of retroperitoneal, intra-abdominal, and intrathoracic metastases with curative intent is now the treatment of choice at clinical reference centers. For urothelial carcinoma that has gone into partial remission after systemic chemotherapy, with full resectability, the resection of metastases prolongs survival from about 13 months to 31-41 months. For prostatic carcinoma with solitary, intrapelvic lymph-node metastases and PSA less than 4 ng/mL, the resection of metastases prolongs 5-year progression-free survival in 40% to 50% of cases. There is, however, no indication for the resection of retro-peritoneal, visceral, or bony metastases. In renal-cell carcinoma, the resection of pulmonary or hepatic metastases is associated with a 5-year survival rate of 40% to 50% or 62%, respectively, and should thus be made a component of the treatment plan for this disease. The indication for resecting metastases of urological cancers should always be established by an interdisciplinary tumor board in the light of the existing scientific evidence.
CONCLUSION
The resection of metastases of some types of urological cancer after chemotherapy can prolong progression-free and overall survival. This form of treatment deserves consideration as a component of individual care and of the interdisciplinary treatment plan for urological cancers.
背景
在睾丸生殖细胞肿瘤中，全身性转移的发生率约为 20%，在前列腺癌中为 25%至 30%，在肌层浸润性尿路上皮癌中为 30%，在肾细胞癌中为 50%。本文对全身药物治疗后泌尿系统肿瘤转移灶切除的最新数据进行了综述。
方法
对有针对性的文献检索中检索到的相关出版物进行了回顾。
结果
没有发表相关的前瞻性、随机对照试验、荟萃分析或 Cochrane 综述。可用于审查的出版物包括指南和证据水平为 IIB 至 III 级的回顾性研究。对于化疗后肿瘤标志物阴性或已达到平台期的非精原细胞瘤生殖细胞肿瘤，具有治愈性意图的腹膜后、腹腔和胸内转移灶切除术是目前临床参考中心的首选治疗方法。对于全身化疗后部分缓解的尿路上皮癌，如完全可切除，转移灶切除术可将生存时间从约 13 个月延长至 31-41 个月。对于 PSA 小于 4ng/ml、单发盆淋巴结转移和前列腺癌，转移灶切除术可使 40%至 50%的病例 5 年无进展生存率延长。然而，对于腹膜后、内脏或骨转移灶，并无切除指征。在肾细胞癌中，肺或肝转移灶切除术的 5 年生存率分别为 40%至 50%或 62%，因此应作为该疾病治疗计划的一部分。应根据现有科学证据，由多学科肿瘤委员会确定是否需要切除泌尿系统癌症的转移灶。
结论
化疗后某些类型的泌尿系统癌症转移灶的切除可延长无进展生存期和总生存期。这种治疗方法值得考虑作为个体化治疗和泌尿系统癌症多学科治疗计划的一部分。
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