Publication: Efectividad de la quimioterapia adyuvante en carcinoma urotelial infiltrante de vejiga tratado cistectomía radical. Resultados de una política adaptada al riesgo
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2017-02-22
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Universidad Complutense de Madrid
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Abstract
El cáncer de vejiga es un importante problema de salud por su incidencia, prevalencia, mortalidad y costes económicos que conlleva. En España el cáncer de vejiga se ubicó como el tumor quinto y séptimo de la incidencia de la mortalidad. La patogénesis del cáncer de vejiga parece estar asociada con el contacto de las sustancias cancerígenas con el epitelio de la vejiga, en particular aminas aromáticas. El epitelio que recubre la pelvis renal, uréteres, vejiga y dos tercios proximales de la uretra, se llama urotelio o epitelio de transición, y los tumores uroteliales se denominan genéricamente carcinomas uroteliales, 90% de los cuales son carcinomas de células transicionales. Para la estadificación del cáncer de vejiga se utiliza el sistema TNM de la American Joint Committee on Cancer (AJCC), en su última actualización de 2010, donde T se refiere al tumor, N a la afectación ganglionar, y M a las metástasis a distancia. Se han descrito hasta un 30-50% las discrepancias entre la estadificación clínica y quirúrgica. En general, por 70 a 75% de los tumores son diagnosticados como tumores no musculo-invasivos (sin invasión de la capa muscular), y sólo requieren un tratamiento local mediante resección tumoral transuretral (RTU), seguido en la mayoría de los casos por quimioterapia intravesical o inmunoterapia. El tratamiento estándar para los tumores invasivos del músculo, es la cistectomía radical. Aproximadamente el 50% de los tumores infiltrantes posteriormente desarrollan metástasis después de la cistectomía radical. Debido a eso, se empezó a recomendar la administración de la quimioterapia perioperatoria, bien antes de la cistectomía (neoadyuvante), o después de la misma (adyuvante), aunque continúa el debate sobre cuál de las dos estrategias es mejor. Por último, la enfermedad metastásica sistémica se considera incurable. El tratamiento de quimioterapia permite aumentar la cantidad y la calidad de vida en algunos pacientes...
Bladder cancer is an important health problem because of its incidence, prevalence, mortality, and economic costs. In Spain bladder cancer is ranked as the 5th and 7th tumor in incidence in mortality. Pathogenesis of bladder cancer appears to be associated with the contact of carcinogenic substances with the bladder epithelium, particularly aromatic amines. The epithelium lining the renal pelvis, ureters, bladder and proximal two-thirds of the urethra, is called urothelium or transitional epithelium, and urothelial tumors are generically called urothelial carcinomas, 90% of which are transitional cell carcinomas (TCC). The TNM staging system of the American Joint Committee on Cancer (AJCC), last updated in 2010, is used for staging, where T relates to tumor, N to nodal involvement and M for distant metastases. There are up to 30-50% discrepancies between clinical and surgical staging. Overall by 70-75% of tumors are diagnosed as non-muscle invasive tumors (without invasion of the muscular layer), and only require a local treatment by transurethral tumor resection (TUR) followed in most cases by intravesical chemotherapy or immunotherapy. The standard treatment for muscle invasive tumors, is radical cystectomy. Approximately 50% of infiltrating tumors subsequently develop metastases after radical cystectomy. Due to that, the administration of perioperative chemotherapy either prior to cystectomy (neoadjuvant) or after cystectomy (adjuvant) was recommended, but both the best strategy and schedule are still debated. Finally, metastatic disease is considered incurable, and subsidiary Systemic chemotherapy, which is given with palliative intent and to increase the amount and quality of life...
Bladder cancer is an important health problem because of its incidence, prevalence, mortality, and economic costs. In Spain bladder cancer is ranked as the 5th and 7th tumor in incidence in mortality. Pathogenesis of bladder cancer appears to be associated with the contact of carcinogenic substances with the bladder epithelium, particularly aromatic amines. The epithelium lining the renal pelvis, ureters, bladder and proximal two-thirds of the urethra, is called urothelium or transitional epithelium, and urothelial tumors are generically called urothelial carcinomas, 90% of which are transitional cell carcinomas (TCC). The TNM staging system of the American Joint Committee on Cancer (AJCC), last updated in 2010, is used for staging, where T relates to tumor, N to nodal involvement and M for distant metastases. There are up to 30-50% discrepancies between clinical and surgical staging. Overall by 70-75% of tumors are diagnosed as non-muscle invasive tumors (without invasion of the muscular layer), and only require a local treatment by transurethral tumor resection (TUR) followed in most cases by intravesical chemotherapy or immunotherapy. The standard treatment for muscle invasive tumors, is radical cystectomy. Approximately 50% of infiltrating tumors subsequently develop metastases after radical cystectomy. Due to that, the administration of perioperative chemotherapy either prior to cystectomy (neoadjuvant) or after cystectomy (adjuvant) was recommended, but both the best strategy and schedule are still debated. Finally, metastatic disease is considered incurable, and subsidiary Systemic chemotherapy, which is given with palliative intent and to increase the amount and quality of life...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 11-01-2016