Efectividad de la quimioterapia adyuvante en carcinoma urotelial infiltrante de vejiga tratado cistectomía radicalresultados de una política adaptada al riesgo

Résumé

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...