James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Eur Urol Focus. 2020 Jul 15;6(4):627-629. doi: 10.1016/j.euf.2019.08.009. Epub 2019 Sep 5.
The ability to accurately determine a complete clinical response (cCR) to neoadjuvant chemotherapy (NAC) before cystectomy could have paradigm-shifting implications for the management of muscle-invasive bladder cancer. Level 1 evidence demonstrates that up to 40% of patients are downstaged to pT0 disease following NAC, presenting an intriguing opportunity to identify select patients who might be spared the morbidity of radical surgery. However, clinical investigations in this space are hindered by lack of a uniform approach to postchemotherapy restaging and a standardized definition of cCR. PATIENT SUMMARY: In this mini-review, we discuss the current limitations to restaging of muscle-invasive bladder cancer following neoadjuvant chemotherapy and their implications for personalized medicine and translational research. We conclude that there is an unmet need to optimize and standardize restaging evaluation and definitions of a complete clinical response.
在膀胱癌根治术前准确判断新辅助化疗（NAC）的完全临床缓解（cCR）能力，可能会对肌层浸润性膀胱癌的治疗模式产生重大影响。1 级证据表明，多达 40%的患者在 NAC 后降期为 pT0 疾病，这为识别可能免受根治性手术带来的发病率的特定患者提供了一个有趣的机会。然而，该领域的临床研究受到缺乏化疗后重新分期的统一方法和 cCR 的标准化定义的阻碍。患者总结：在本次小型综述中，我们讨论了新辅助化疗后肌层浸润性膀胱癌重新分期的当前局限性及其对个体化医学和转化研究的影响。我们得出的结论是，需要优化和标准化重新分期评估以及完全临床缓解的定义。
