Suzuki Kotaro, Murata Kazuki, Wakita Naoto, Terakawa Tomoaki, Nakanishi Takaaki, Hara Takuto, Hyodo Yoji, Chiba Koji, Teishima Jun, Nakano Yuzo, Miyake Hideaki
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku 650-0017, Kobe, Japan.
Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.
Int Cancer Conf J. 2024 Jul 2;13(4):391-394. doi: 10.1007/s13691-024-00695-1. eCollection 2024 Oct.
Metastatic upper tract urothelial carcinoma (mUTUC) often has poor prognosis. While systemic therapy is the standard care for mUTUC, lymph node dissection (LND) combined with radical nephroureterectomy (RNU) can be considered for patients with only clinical locoregional LN, resulting in a surgical cure. However, since pembrolizumab, an anti-PD-1 monoclonal antibody, was approved for mUTUC patients, prognosis of mUTUC has been improved and some patients with immune-related adverse events have experienced a clinical complete response and a long-lasting therapeutic response without surgery. Thus, clarifying the optimal patient selection and timing for RNU + LND is warranted to avoid unnecessary surgery. We herein report the first unique case with a clinical N + UTUC patient who underwent RNU plus LND and showed a pathological complete response after discontinuation of pembrolizumab due to adrenal insufficiency. We feel that our case may affect the treatment strategy for N + UTUC in the era of ICIs.
转移性上尿路尿路上皮癌（mUTUC）的预后通常较差。虽然全身治疗是mUTUC的标准治疗方法，但对于仅存在临床局部区域淋巴结转移的患者，可考虑行淋巴结清扫术（LND）联合根治性肾输尿管切除术（RNU），从而实现手术治愈。然而，自从抗程序性死亡蛋白1（PD-1）单克隆抗体帕博利珠单抗被批准用于mUTUC患者以来，mUTUC的预后得到了改善，一些发生免疫相关不良事件的患者在未接受手术的情况下实现了临床完全缓解和持久的治疗反应。因此，有必要明确RNU + LND的最佳患者选择和时机，以避免不必要的手术。我们在此报告首例独特病例，该临床N + UTUC患者接受了RNU加LND治疗，因肾上腺功能不全停用帕博利珠单抗后显示病理完全缓解。我们认为我们的病例可能会影响免疫检查点抑制剂（ICI）时代N + UTUC的治疗策略。
