Tan Wei Shen, Lamb Benjamin W, Payne Heather, Hughes Simon, Green James S A, Lane Tim, Adshead Jim, Boustead Greg, Vasdev Nikhil
Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom.
Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Clin Genitourin Cancer. 2015 Jun;13(3):e153-8. doi: 10.1016/j.clgc.2014.11.006. Epub 2014 Nov 20.
Because of the lack of published evidence, this study was done to explore the decisions and rationale of uro-oncology consultants regarding the treatment of patients with muscle-invasive bladder cancer who have positive lymph nodes after radical cystectomy (RC) and neoadjuvant chemotherapy (NAC).
An electronic survey was sent to UK pelvic cancer centers regarding: (1) choice of NAC regimen; (2) indications for reimaging; (3) choice and indication of adjuvant chemotherapy (AC) for patients with nodal disease after NAC and RC; (4) choice and indication of chemotherapy regimen if disease continues to progress in patients with advanced bladder cancer; and (5) guidelines used by those surveyed.
Consultant uro-oncologists from 77% of UK pelvic cancer centers responded, who treated a median of 13 patients per year with NAC before RC. Three cycles of gemcitabine and cisplatin was the most common NAC regimen, with 93% and 67% respondents giving it for downstaging of cN1- and cN2- and 3-positive patients, respectively. Forty-five percent would not give AC after NAC and RC in patients with positive lymph nodes. The patient's performance status, followed by response to NAC were key factors in dictating the use of AC. In the presence of disease progression, 46% of participants would use a taxane. Fifty-two percent of responders do not follow any guidelines.
In the United Kingdom, the treatment of patients with nodal disease after NAC and RC is variable. There is little evidence on which to base the management of such patients. The creation of national and international guidelines might help clinicians to optimize care for these patients.
由于缺乏已发表的证据，本研究旨在探讨泌尿肿瘤学顾问对于根治性膀胱切除（RC）和新辅助化疗（NAC）后淋巴结阳性的肌层浸润性膀胱癌患者的治疗决策及依据。
向英国盆腔癌中心发送了一项电子调查问卷，内容涉及：（1）NAC方案的选择；（2）再次成像的指征；（3）NAC和RC后淋巴结疾病患者辅助化疗（AC）的选择及指征；（4）晚期膀胱癌患者疾病持续进展时化疗方案的选择及指征；（5）被调查者所使用的指南。
来自77%英国盆腔癌中心的泌尿肿瘤学顾问做出了回应，他们在RC前每年平均用NAC治疗13例患者。吉西他滨和顺铂的三周期方案是最常用的NAC方案，分别有93%和67%的受访者将其用于cN1 - 、cN2 - 和3阳性患者的降期治疗。45%的人不会对淋巴结阳性的患者在NAC和RC后给予AC。患者的体能状态，其次是对NAC的反应，是决定是否使用AC的关键因素。在疾病进展的情况下，46%的参与者会使用紫杉烷。52%的受访者不遵循任何指南。
在英国，NAC和RC后淋巴结疾病患者的治疗存在差异。几乎没有证据可作为此类患者管理的依据。制定国家和国际指南可能有助于临床医生优化对这些患者的治疗。
