新辅助化疗在上尿路尿路上皮癌中的研究进展

Advances in neoadjuvant chemotherapy in upper tract urothelial carcinoma

上尿路尿路上皮癌(UTUC)目前仍以直接行肾脏输尿管全切为主流治疗方式,但其术后五年生存率仍不足50%,远低于膀胱尿路上皮癌。新辅助化疗(NAC)在膀胱尿路上皮癌中已经成为有一级证据的一线治疗方案。在UTUC中,NAC具有潜在的降低临床和病理分期、更优肿瘤学结局、术前更高肾脏负担、降低膀胱复发率等优点,极高的应答率和低于120 d的化疗周期或许也能化解对化疗期间疾病进展的担忧。然而NAC在化疗方案上基本沿用来自膀胱尿路上皮癌的经验,但二者近年来越来越多的证据表明可能来自于不同的胚层,其生物学行为也存在差异性,并且新的免疫检查点抑制剂的出现也在动摇着NAC的应用和推广。越来越多的研究在推动着NAC的发展,但目前仍然存在诸多争议。本文回顾了近年来NAC在UTUC中的治疗方案、潜在获益等数据,系统探讨NAC在UTUC的应用进展。

Upper tract urothelial carcinoma (UTUC) is still mainly managed by radical nephroureterectomy with the 5-year survival rate less than 50%, which is much lower than urothelial carcinoma in bladder. Neoadjuvant chemotherapy (NAC) has become a first-line treatment with category 1 evidence in bladder urothelial carcinoma. In UTUC, NAC has the potential to reduce both clinical and pathological staging, better oncological outcomes, higher preoperative renal burden, and lower bladder recurrence rate. A high response rate and a chemotherapy cycles of less than 120 days may also resolve concerns about disease progression during chemotherapy. Although NAC has basically followed the experience of treating bladder urothelial carcinoma in chemotherapy, there has been increasing evidence in recent years that it may come from different germ layers, and its biological behavior is also different. The emergence of immune checkpoint inhibitors is also shaking the application and promotion of NAC. More and more studies are driving the development of NAC, but there are still many controversies. This article reviews the recent treatments and potential benefits of NAC in UTUC, and systematically explores the application of NAC in UTUC.