University of Texas Southwestern Medical Center, Dallas, TX, USA.
Curr Urol Rep. 2013 Apr;14(2):94-101. doi: 10.1007/s11934-013-0307-z.
Upper tract urothelial cancer (UTUC) accounts for roughly 5 % of all urothelial cancers. At presentation, 30 % of patients demonstrate invasive and/or locally advanced disease, 30-40 % have regional lymph node involvement, and 20 % harbor metastatic disease. Systemic recurrence and progression rates after surgery for patients with advanced disease range between 45-60 %. Five-year cancer specific survival rates for pT2 and pT3 tumors are 73 % and 40 %, respectively. Median survival for patients with pT4 disease is approximately 6 months. Nonetheless, there is a lack of improvement in the rates of systemic recurrence and progression in patients with advanced UTUC. Extrapolating evidence obtained from experience with multi-modal therapy of patients with urothelial bladder cancer, additional improvements in oncological outcomes for patients with UTUC can be achieved through integration of effective systemic chemotherapy with local tumor control. We provide an overview of the rationale and utilization strategies of peri-operative systemic chemotherapy in patients with UTUC.
上尿路尿路上皮癌（UTUC）约占所有尿路上皮癌的 5%。在就诊时，30%的患者表现为浸润性和/或局部晚期疾病，30-40%有区域淋巴结受累，20%有转移性疾病。对于晚期疾病患者，手术后系统复发和进展的比率在 45-60%之间。pT2 和 pT3 肿瘤的 5 年癌症特异性生存率分别为 73%和 40%。pT4 疾病患者的中位生存期约为 6 个月。尽管如此，晚期 UTUC 患者的系统复发和进展率仍未见改善。从多模式治疗膀胱癌患者的经验中推断，通过将有效的全身化疗与局部肿瘤控制相结合，可以为 UTUC 患者实现肿瘤学结局的进一步改善。我们对上尿路尿路上皮癌患者围手术期全身化疗的原理和应用策略进行了综述。
