肌肉浸润性膀胱癌(MIBC)管理
RuiyunTALK瑞赟说特邀嘉宾：
范德比尔特-英格拉姆癌症中心(VICC) BRIAN RINI教授
主持：
上海交通大学医学院附属仁济医院 张瑞赟 教授
| Publishes | Daily | Episodes | 4 | Founded | 8 days ago |
|---|---|---|---|---|---|
| Language |  ZH-CN | Categories | MedicineHealth & FitnessTechnology | ||
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导语保膀胱治疗是MIBC患者的重要治疗选择，尤其对于高龄、基础疾病多或强烈希望保留膀胱功能的患者，其核心目标是在保证肿瘤控制的前提下，最大限度提升生活质量。传统的三联疗法（经尿道切除术+放疗+化疗，TMT）已应用多年，但随着EV+P等高效围手术期方案、ctDNA/UTDNA等监测工具的出现，保膀胱治疗的模式正在发生深刻变革。无化疗保膀胱策略的探索、RETAIN等标志物指导研究的启示，为保膀胱治疗的精准化与个体化提供了新方向。本部分围绕保膀胱治疗的现状、创新策略与未来趋势，以一问一答形式展开讨论。... more
导语：新辅助治疗是MIBC综合治疗的核心环节，其目标是缩小肿瘤体积、降低分期、提高手术切除率与治愈率。随着EV-303、EV-304等研究的阳性结果公布，EV+P联合方案凭借高病理完全缓解率与生存优势，正在重塑MIBC新辅助治疗的标准。同时，分子标志物的应用、变异组织学患者的治疗选择，以及ctDNA/UTDNA在疗效监测中的价值，成为当前研究与临床实践的热点。本部分围绕新辅助治疗方案优选、分子标志物应用与疗效监测手段，以一问一答形式展开讨论。张瑞赟 教授：您目前治疗MIBC的一线首选新辅助治疗方... more
导语：辅助治疗是MIBC患者根治性手术后降低复发风险、改善生存预后的关键环节。随着EV系列研究等重磅成果的公布，EV+P（Enfortumab Vedotin+Pembrolizumab）围手术期模式展现出显著优势，而病理完全缓解（pCR）状态、肿瘤分期等因素，为辅助治疗方案的个体化选择提供了重要依据。本部分围绕新辅助治疗后不同病理反应患者的辅助治疗策略、争议焦点及决策依据，以一问一答形式展开深入探讨。张瑞赟 教授：新辅助化疗/EV方案治疗后达到病理完全缓解（ypCR）的MIBC患者，是否需要进... more
导语：液态活检技术的发展为MIBC辅助治疗的精准化提供了新工具，循环肿瘤DNA（ctDNA）作为反映微小残留病灶（MRD）的核心指标，在CheckMate 274、IMvigor011等研究中已展现出重要的预后与预测价值。ctDNA是否应常规用于指导辅助免疫治疗决策、最佳检测频率如何设定、检测结果（尤其是变异等位频率VAF）如何标准化解读，这些问题直接影响其临床转化与应用。本部分围绕ctDNA在辅助免疫治疗中的实践应用，以一问一答形式展开讨论。张瑞赟 教授：您在临床实践中是否常规使用ctDNA来... more
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