Lim Amy H, Westerman Mary E, Korokovic Andrea, Matulay Justin T, Narayan Vikram M, Navai Neema
Department of Urology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Bladder Cancer. 2022 Jun 3;8(2):193-209. doi: 10.3233/BLC-211529. eCollection 2022.
The benefit of surgery of the primary tumor in metastatic bladder cancer is unknown.
Perform a comprehensive contemporary literature review on the benefit of surgery of the primary tumor in metastatic bladder cancer.
Ovid MEDLINE, Ovid EMBASE, and Cochrane Library from January 1, 1990 to April 20, 2020 were queried for relevant articles published in English. Each article was evaluated by at least two content experts prior to inclusion which were blinded to the other's evaluation. A third content expert was used when there was not a unanimous decision. Additional articles were added at the discretion of the authors.
Long-term survival is possible in patients with initially unresectable and/or limited metastatic disease. Multi-modal therapy with chemotherapy and surgery have the most favorable outcomes when compared to single treatment modalities in selected populations. Patients who demonstrate a robust response to pre-surgical therapy are likely to benefit the most from consolidative surgery. Patients with distant metastatic disease may benefit from consolidative surgery; however, this benefit may only be seen in those with metastatic disease limited to one site.
Surgery of the primary tumor in metastatic bladder cancer either in the setting of surgery alone, consolidative therapy or coupled with adjuvant therapy may be beneficial in well selected patients and should generally be limited to those who have a response to primary chemotherapy. Randomized clinical control trials are needed to further our understanding of the role of surgery in metastatic bladder cancer.
转移性膀胱癌原发肿瘤手术的益处尚不清楚。
对转移性膀胱癌原发肿瘤手术的益处进行全面的当代文献综述。
检索1990年1月1日至2020年4月20日期间发表在英文期刊上的相关文章，检索数据库包括Ovid MEDLINE、Ovid EMBASE和Cochrane图书馆。每篇文章在纳入前至少由两名内容专家进行评估，评估过程中专家对彼此的评估结果不知情。若意见不一致，则由第三位内容专家参与评估。作者可自行决定是否添加其他文章。
初始不可切除和/或局限性转移性疾病患者有可能实现长期生存。与单一治疗方式相比，化疗和手术的多模式治疗在特定人群中具有最有利的结果。对术前治疗有强烈反应的患者可能从巩固性手术中获益最大。远处转移性疾病患者可能从巩固性手术中获益；然而，这种益处可能仅见于转移病灶局限于一个部位的患者。
转移性膀胱癌原发肿瘤手术，无论是单纯手术、巩固性治疗还是联合辅助治疗，在精心挑选的患者中可能有益，一般应限于对一线化疗有反应的患者。需要进行随机临床对照试验，以进一步了解手术在转移性膀胱癌中的作用。
