摘要
探讨经尿道最大化膀胱肿瘤电切术(mTURBT),联合化疗和免疫治疗,同步放疗以及免疫维持治疗的“四联”保膀胱模式的安全性和疗效。回顾性分析2019年11月至2021年10月北京大学肿瘤医院泌尿外科收治的8例不耐受或拒绝膀胱根治性切除的膀胱癌患者资料。男5例,女3例,平均年龄69(42~83)岁。美国东部肿瘤协作组(ECOG)评分6例0分,2例1分。单纯高级别尿路上皮癌5例(1例T3b期;2例T2期;2例T1期,肿瘤多发且反复复发);高级别尿路上皮癌合并原位癌1例(T1/Tis期);高级别尿路上皮癌伴鳞状分化1例(T3b期);高级别尿路上皮癌伴腺样分化1例(T2期)。患者均行“四联”保膀胱治疗模式。随访评估患者耐受性、保留膀胱成功率及预后情况。中位随访22.5(12~35)个月。1例膀胱单纯高级别尿路上皮癌(T2)患者,接受mTURBT、白蛋白紫杉醇+度伐利尤单抗联合治疗3周期、同步放疗和单药免疫维持保膀胱治疗18个月,复查发现肿瘤复发,病理为高级别尿路上皮癌。余7例患者定期规律复查,未见膀胱肿瘤复发或转移。患者2年无进展生存率为80%,保留膀胱成功率为87.5%(7/8),治疗相关不良反应经对症处理好转,患者依从性及耐受性良好。“四联”保膀胱综合治疗具有可行性,总体疗效和耐受性良好,但仍需进一步研究评估。
To investigate the safety and efficacy of"quadri-combination"therapy including maximal transurethral resection of bladder tumor(mTURBT),combined with systemic chemotherapy and immunotherapy,concurrent radiotherapy,and immune maintenance therapy.The clinical data of 8 patients with bladder cancer who could not tolerate or refused radical cystectomy at the Department of Urology,Peking University Cancer Hospital from November 2019 to October 2021 were retrospectively analyzed.There were 5 males and 3 females with a mean age of 69 years.The Eastern Cooperative Oncology Group(ECOG)score was 0 in 6 cases and 1 in 2 cases.There were 5 cases of high-grade urothelial carcinoma(1 case of T3b;2 cases were T2;2 cases of T1 stage,with multiple tumors and repeated recurrence),1 case of high-grade urothelial carcinoma with carcinoma in situ(T1/Tis stage),1 case of high-grade urothelial carcinoma with squamous differentiation(T3b stage),and 1 case of high-grade urothelial carcinoma with glandular differentiation(T2).All patients underwent"quadri-combination"therapy.The patient′s tolerance,success rate of bladder preservation and prognosis were evaluated.The median follow-up time was 22.5(12-35)months.One patient with high-grade muscle-invasive bladder cancer(T2)received mTURBT,albumin-bound paclitaxel and durvalumab combined therapy for 3 cycles,concurrent radiotherapy,and immune maintenance therapy for 18 months,and the tumor recurrence was found.The pathology was high-grade urothelial carcinoma.Salvage radical cystectomy combined with pelvic lymph node dissection is recommended.The remaining 7 patients were regularly reexamined,and no recurrence or metastasis was found.The 2-year progression-free survival rate was 80%,and the success rate of bladder preservation was 87.5%(7/8).Treatment-related adverse reactions were resolved by symptomatic treatment,and patients′compliance and tolerance were acceptable.The"quadri-combination"bladder-preserving therapy is feasible and well tolerated,but further studies are needed.
作者
洪保安
赵强
纪永鹏
曹煜东
杨勇
张宁
Hong Baoan;Zhao Qiang;Ji Yongpeng;Cao Yudong;Yang Yong;Zhang Ning(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Urology,Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Urology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第24期1855-1859,共5页
National Medical Journal of China
基金
北京市希思科-领航肿瘤研究基金(Y-2019AZZD-0369)
北京白求恩公益基金(mnzl202003)
关键词
膀胱肿瘤
保留膀胱
同步放化疗
免疫治疗
预后
Urinary bladder neoplasms
Bladder preservation
Concurrent chemoradiotherapy
Immunotherapy
Prognosis
作者简介
通信作者:张宁,Email:niru7429@126.com
