University of Virginia, Department of Urology, Charlottesville, Virginia, USA.
Curr Opin Urol. 2022 Nov 1;32(6):614-617. doi: 10.1097/MOU.0000000000001034. Epub 2022 Sep 8.
Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy.
Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy.
Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations.
根治性手术在局部晚期尿路上皮癌的治疗策略中可发挥重要作用。本次综述旨在传递过去 12 个月文献中关于手术切除在膀胱和上尿路局部晚期尿路上皮癌中的应用、手术结果和肿瘤疗效的最新信息。
多模式治疗是局部晚期尿路上皮癌长期总生存的关键。对于 cT4 或 cN2 及以上局部淋巴结阳性的膀胱疾病，在观察到对化疗或免疫治疗有反应后，可进行根治性膀胱切除术和双侧盆腔淋巴结清扫术。此外，三联疗法后行根治性膀胱切除术也可获得持久的局部缓解。对于上尿路疾病，肾输尿管切除术联合区域淋巴结清扫术是主要的手术方式，常与围手术期顺铂为基础的化疗联合使用。
对于局部晚期尿路上皮癌患者，手术切除作为单一疗法并不能治愈。然而，在某些患者中，联合全身药物治疗可增强持久的长期生存。未来需要研究那些接受局部晚期疾病巩固性手术治疗的患者的患者报告结果，以指导临床推荐。
