Arjun Vasant Balar, New York University, New York, NY.
J Clin Oncol. 2017 Jul 1;35(19):2109-2112. doi: 10.1200/JCO.2017.72.8444. Epub 2017 May 8.
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 62-year-old man with a 45 pack per year tobacco-smoking history presented with painless gross hematuria in the fall of 2015 and was ultimately diagnosed with muscle-invasive urothelial bladder cancer. He received four cycles of cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy with pelvic lymph node dissection, which disclosed residual high-grade muscle-invasive urothelial cancer extending to the perivesical fat and involving two of 20 pelvic lymph nodes (pT3N2). Six months later, surveillance imaging identified new retroperitoneal lymphadenopathy and a large right pelvic mass with possible rectal wall invasion consistent with locally recurrent and metastatic urothelial cancer. Although feeling generally well, he reported having had progressive constipation, pelvic pressure, and narrow-caliber stools for 2 months. He was seen in consultation for management of recurrent bladder cancer.
肿瘤学大查房系列旨在将发表在《临床肿瘤学杂志》上的原始报告置于临床背景下。病例介绍后，将描述诊断和治疗挑战，回顾相关文献，并总结作者建议的治疗方法。本系列的目标是帮助读者更好地理解如何将关键研究的结果（包括发表在《临床肿瘤学杂志》上的研究结果）应用于他们自己临床实践中看到的患者。一位 62 岁男性，有 45 包/年的吸烟史，于 2015 年秋季出现无痛性肉眼血尿，最终被诊断为肌层浸润性膀胱尿路上皮癌。他接受了四个周期的顺铂为基础的新辅助化疗，随后进行根治性膀胱切除术和盆腔淋巴结清扫术，结果显示残留的高级别肌层浸润性尿路上皮癌累及膀胱周围脂肪和 20 个盆腔淋巴结中的 2 个（pT3N2）。6 个月后，监测影像学检查发现新的腹膜后淋巴结肿大和右侧骨盆大肿块，可能侵犯直肠壁，符合局部复发性和转移性尿路上皮癌。尽管他一般感觉良好，但他报告说已经有 2 个月的进行性便秘、骨盆压迫和细便。他因复发性膀胱癌就诊。
