肌层浸润性尿路上皮癌辅助治疗的研究进展  

Current advances in research on adjuvant therapy for muscle-invasive urothelial carcinoma

作　　者：杨恺惟[1] 陈宇珂[1] 郭璇骏 何志嵩[1] Yang Kaiwei;Chen Yuke;Guo Xuanjun;He Zhisong(Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院泌尿外科,北京100034

出　　处：《中华泌尿外科杂志》2024年第10期800-804,共5页Chinese Journal of Urology

摘　　要：肌层浸润性膀胱癌(MIBC)是肌层浸润性尿路上皮癌(MIUC)的主要类型。MIBC的预后较差且治疗手段有限。2021年以前核心策略为新辅助化疗联合根治性膀胱切除术,2021年之后以纳武利尤单抗为代表的免疫治疗探索取得突破性进展,显著改善了高风险MIUC人群的无疾病生存,成为MIUC辅助治疗的标准方案之一。与辅助化疗相比,免疫治疗兼具良好的有效性和安全性优势。目前尚未确立辅助治疗的预测因子。程序性死亡配体1(PD-L1)表达水平、循环肿瘤DNA等是探索较多的预测免疫治疗反应的生物标志物,未来的研究有必要评估上述生物标志物的价值。免疫治疗与化疗或抗体偶联药物联合用于围手术期的研究正在进行中;此外免疫治疗在MIUC保膀胱治疗中的应用目前仍为小规模研究,早期探索结果令人鼓舞。未来Ⅲ期研究将为辅助免疫治疗保膀胱策略增加成熟数据。Muscle-invasive bladder cancer(MIBC)is the predominant type of muscle-invasive urothelial carcinoma(MIUC).MIBC features an unfavorable prognosis with limited treatment approaches.The backbone of treatment strategy was neoadjuvant chemotherapy followed by radical cystectomy before 2021.Immunotherapy represented by nivolumab has gained breakthrough results in adjuvant setting,demonstrating significant improvement in disease free survival in high-risk MIUC population,and become a standard of care for MIUC adjuvant therapy since 2021.Immunotherapy has both efficacy and safety advantages compared to adjuvant chemotherapy.Predictors for adjuvant therapy response in MIUC have yet not been identified.The most evaluated predictive biomarkers to date for immune checkpoint inhibitor treatment response are programmed death ligand 1(PD-L1)expression and circulating tumour DNA(ctDNA),etc.Further research is crucial to assess the value of the biomarkers.Studies of perioperative immunotherapy combined with chemotherapy or antibody-drug conjugate are ongoing.Combined immunotherapy as part of bladder-sparing treatment regimen for MIUC is limited to small scale studies and has shown promising early outcomes.Further phase 3 clinical trials are underway to add mature data to bladder-sparing strategies incorporating immune checkpoint inhibitors in adjuvant setting.

关 键 词：尿路上皮癌 肌层浸润性膀胱癌 辅助治疗 免疫治疗 纳武利尤单抗 

分 类 号：R737.1[医药卫生—肿瘤]