Mandalapu Rao S, Matin Surena F
Houston, TX.
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
Urology. 2016 Aug;94:17-23. doi: 10.1016/j.urology.2015.12.035. Epub 2016 Feb 2.
Radical nephroureterectomy with en bloc bladder cuff excision and regional lymphadenectomy is the gold standard for the management of high-grade and high-risk upper tract urothelial carcinomas. There are a few prospective randomized controlled studies in this uncommon and often aggressive disease to support level-1 management guidelines. However, recent developments in imaging, minimally invasive techniques, lymphatic dissemination, and bladder cancer prevention raise the hope for improved risk stratification and treatments without compromising, and hopefully improving, oncological outcomes. Multimodality approaches in terms of neoadjuvant, adjuvant topical, and systemic chemotherapeutic regimens are promising, with 2 prospective trials either open or in development.
根治性肾输尿管切除术联合整块膀胱袖口状切除术及区域淋巴结清扫术是治疗高级别和高危上尿路尿路上皮癌的金标准。对于这种罕见且通常侵袭性强的疾病，仅有少数前瞻性随机对照研究来支持一级管理指南。然而，影像学、微创技术、淋巴转移及膀胱癌预防方面的最新进展为改善风险分层及治疗带来了希望，且不影响甚至有望改善肿瘤学结局。新辅助、辅助局部及全身化疗方案的多模式方法前景广阔，有2项前瞻性试验正在进行或即将开展。
