复发性膀胱癌的多学科联合诊疗及文献复习  

Multi-disciplinary treatment in recurrent bladder cancer and literature review

作　　者：刘磊[1] 张远鹏 樊继全[2] 苏扬波 周迪炜 蒋国松 章小平 LIU Lei;ZHANG Yuanpeng;FAN Jiquan;SU Yangbo;ZHOU Diwei;JIANG Guosong;ZHANG Xiaoping(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China;Department of Clinical Oncology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology;Department of Interventional Radiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology;Department of Pathology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022 [2]华中科技大学同济医学院附属协和医院肿瘤科 [3]华中科技大学同济医学院附属协和医院介入放射科 [4]华中科技大学同济医学院附属协和医院病理科

出　　处：《临床泌尿外科杂志》2023年第11期886-892,共7页Journal of Clinical Urology

基　　金：国家自然科学基金项目资助(No:82102787)。

摘　　要：本文介绍1例在经过膀胱癌根治术后出现复发的肌层浸润性膀胱癌患者的多学科联合诊疗(MDT)过程。该患者在诊断性电切明确病理诊断后,行新辅助化疗+免疫治疗,病灶出现部分缓解。随后对该患者进行膀胱癌根治术+回肠通道术,术后进行2周期辅助化疗+免疫治疗,后续进行免疫治疗维持,但患者因疲乏、食欲不振中断治疗。后定期复查,于术后1年余开始发现腹膜后淋巴结转移合并肾积水以及骨转移。经MDT团队讨论,在全身系统治疗方面,对该患者再次进行了化疗+免疫治疗,病情再次反复后,改为抗体药物偶联物(ADC)类药物(维迪西妥单抗治疗);在局部治疗方面,介入放射科进行了顺行输尿管狭窄段球囊扩张+输尿管支架置入,肿瘤科进行了针对骨转移灶的放射治疗,病情得到有效控制。整个诊疗过程体现了MDT团队能够综合动态评估患者病情、快速调整诊治策略的优势,为患者提供了个体化治疗方案并使其获得了更好的生活质量。This article introduced the multi-disciplinary treatment(MDT)of a patient with recurrent muscle-invasive bladder cancer.Firstly,the patient underwent neoadjuvant chemotherapy+immunotherapy after confirmed pathological diagnosis,and the lesion showed partial response.Subsequently,the patient underwent radical cystectomy,two cycles of adjuvant chemotherapy+immunotherapy and maintenance immunotherapy were performed thereafter.But the treatment was terminated due to fatigue and anorexia.During routine follow-up,retroperitoneal lymph node metastasis,hydronephrosis and bone metastasis were found about one year after surgery.MDT team worked out some recommendations.In terms of systemic treatment,chemotherapy and immunotherapy were performed again,and after recurrence happened once again,the patient was treated with HER2 ADC(RC48).In terms of local treatment,interventional radiologist carried out balloon dilation of the ureter and ureteral stent placement,and radiation oncologist carried out radiation therapy on bone metastases.Finally,the disease was effectively controlled.The entire treatment process shows the advantages of the MDT team in assessing the patient's condition dynamically and adjusting the treatment strategy efficiently.MDT team could provide the patients with individualized treatment plans and better quality of life.

关 键 词：复发性膀胱癌 化疗 免疫治疗 抗体药物偶联物 放疗 

分 类 号：R737.14[医药卫生—肿瘤]