Department of Urology, Graduate School of Medical Sciences, Kyushu University.
Division of Urology, Harasanshin Hospital, Fukuoka.
Jpn J Clin Oncol. 2020 Apr 7;50(4):357-367. doi: 10.1093/jjco/hyaa013.
Although surgery with curative intent is critical for management of many localized cancers, multimodal therapy including neoadjuvant and adjuvant therapy has been introduced to increase the effectiveness of local control of surgery and prolong survival. However, strong evidence supporting the utility of such multimodal therapy is limited. The utility of perioperative chemotherapy has been extensively investigated in bladder cancer, and several randomized controlled trials have indicated the benefit of neoadjuvant cisplatin-based chemotherapy in muscle-invasive bladder cancer. Regrettably, perioperative therapy for other urological cancers is controversial; therefore, no definitive conclusions have been drawn. Recently, the number of trials has rapidly increased due to the development of immune checkpoint inhibitors, used alone or in combination with other modalities. In this review, we summarize the current status and supporting evidence for perioperative therapies such as neoadjuvant and adjuvant therapies for urological cancers, including prostate cancer, urothelial cancer and renal cell carcinoma.
尽管具有治愈意图的手术对于许多局限性癌症的治疗至关重要,但已引入包括新辅助和辅助治疗在内的多模式治疗,以提高手术局部控制的效果并延长生存时间。然而,支持这种多模式治疗的有效性的有力证据有限。围手术期化疗在膀胱癌中的应用已得到广泛研究,几项随机对照试验表明新辅助顺铂为基础的化疗对肌层浸润性膀胱癌有益。遗憾的是,其他泌尿系统癌症的围手术期治疗仍存在争议;因此,尚无明确结论。最近,由于免疫检查点抑制剂的开发,单独使用或与其他方式联合使用,试验数量迅速增加。在这篇综述中,我们总结了围手术期治疗(如新辅助和辅助治疗)在前列腺癌、尿路上皮癌和肾细胞癌等泌尿系统癌症中的现状和支持证据。