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发布者:鑫达医学翻译 发布时间:2013-06-18 8:50:52 阅读:

Expert commentary

Currently available data suggest that partial cystectomy with en bloc resection of the urachal ligament and umbilicus can lead to long-term disease control in patients with surgically resectable urachal carcinoma. Risk factors associated with recurrence following surgery include positive margins, lymph node or other metastases at the time of surgery, and a failure to resect the umbilicus en bloc with the urachal ligament and bladder. Although adjuvant chemotherapy should not yet be considered standard in the setting of this disease, it is reasonable to offer adjuvant treatment to those patients at high risk of recurrence based upon these risk factors. Our current front-line chemotherapy regimen in the setting of adjuvant or metastatic therapy is the Gem-FLP combination. In those with measurable unresectable disease, this regimen has an approximately 35–40% objective response rate with one clinical CR who is alive and free of disease at more than 2 years. Tumor markers, including CEA, CA125 and CA19–9, may be helpful in evaluating response to systemic chemotherapy. Additional surgical consolidation may also be helpful in patients with positive margins or who have not had en bloc resection of the urachal ligament, even though there is currently no definitive data supporting this strategy. Prospective studies are necessary to help better define those patients at high risk for recurrence and whether there is any benefit through the addition of systemic chemotherapy. Supporting clinical trials in urachal cancer is strongly encouraged. 

专家评论

现有数据提示,部分膀胱切除术(切除整个脐尿管韧带和脐部)可能会使得可实施手术切除的脐尿管癌患者的病情得到长期控制。术后复发相关的风险因素包括切缘含肿瘤细胞、手术时发生淋巴结或其他转移,以及脐尿管、膀胱与脐部切除失败。尽管辅助化疗尚未被采纳为该疾病的标准疗法,但可以对高复发风险的患者提供辅助治疗。当前,我们在进行辅助或转移治疗时所使用的一线化疗方法是Gem-FLP。对于那些不能实施切除术的患者,这种化疗方案的应答率35-40%,有1例患者出现完全缓解(CR),并摆脱疾病超过2年。肿瘤标志物,包括CEA、CA125和CA19-9可能对评价系统化疗的应答有所帮助。即使目前尚无明确数据支持,针对切缘无肿瘤的患者,或者未接受脐尿管韧带整体切除的患者,也可进行采用联合手术进行治疗。后续研究应重视那些有高复发风险的患者,以及系统化疗是否有利于疾病控制。建议多开展脐尿管癌相关的临床试验。

 

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