首页膀胱肿瘤治疗及预后证据详情

A Systematic Review and Meta-analysis of Delay in Radical Cystectomy and the Effect on Survival in Bladder Cancer Patients

原文: 2020 年 发布于 Journal of Urology 203 卷 第 2 期 131-145 浏览量:229次

作者: Russell B. Liedberg F. Khan M. S. Nair R. Thurairaja R. Malde S. Kumar P. Bryan R. T. Van Hemelrijck M.

作者单位: Department of Urology, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia. Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany. Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany. georgios.gakis@med.uni-tuebingen.de.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.1080/01635581.2018.1512636

关键词: Carcinoma Transitional Cell/*diagnostic imaging/pathology/surgery Cystectomy Humans Lymph Nodes/*diagnostic imaging/pathology Lymphatic Metastasis/diagnostic imaging Magnetic Resonance Imaging Neoplasm Staging Positron Emission Tomography Computed Tomography Sensitivity and Specificity Tomography X-Ray Computed Urinary Bladder Neoplasms/*diagnostic imaging/pathology/surgery Bladder cancer Computed tomography Positron emission tomography Transitional cell carcinoma

文献简介

BACKGROUND: Patients with advanced urothelial carcinoma (UC) have poor outcomes, with 5-year survival rates of <5% for those with metastatic, stage IV disease. We have reviewed current treatment paradigms and emerging treatment options for these patients. METHODS: The websites of seven national or international organizations were searched for metastatic UC treatment guidelines. Systematic literature reviews were conducted to identify evidence from randomized controlled trials (RCTs) of chemotherapy for patients with previously untreated, unresectable, stage IV UC. Searches included congress databases and articles published between 1990 and 2018. In order to align with the latest treatment paradigms in first-line advanced UC, a focused literature search was conducted to identify evidence supporting immuno-oncology (IO) agents. RESULTS: For advanced UC, guidelines universally recommend cisplatin-based chemotherapy as first-line treatment for eligible patients and carboplatin-based regimens for those unfit to receive cisplatin. Despite the evaluation of a number of different cytotoxic regimens over the years, including triplet combinations, survival outcomes have not improved markedly with chemotherapy. Median overall survival with standard of care chemotherapy is ~13 months. Based on the results of single-arm, phase II studies, recent treatment guidelines have included atezolizumab (anti-PD-L1) and pembrolizumab (anti-PD-1) as first-line options for cisplatin-ineligible patients whose tumors express high levels of PD-L1. However, emerging evidence from RCTs of IO agents, including both cisplatin-eligible and cisplatin-ineligible patients, suggest that survival times exceeding 20 months are possible. CONCLUSIONS: After having reached a plateau with chemotherapy, the treatment landscape for advanced UC is evolving. Survival outcomes for patients with advanced UC are improving with treatment modalities involving IO agents.

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