570
www.onkologiecs.cz3408040010765133201214262311348396415464514532576617652669709748
6956558020012657115
/39898040010732
Onkologie.40668040010760109147194214262312331375389
2025;19(2):69-754475804001074487128172185223261285327350364409452481521562
/50828040010731
ONKOLOGIE51598040010761120167227270329388409453
HLAVNÍ4945200012671127198263336370
TÉMA5337200012657114204274
Současné366236001063171112147189223263295
možnosti397336001065292123165206238271289
adjuvantní427736001063878100141179216257289331348
léčby46413600106296196132168
uroteliálních482536001063974115145177209227266297339356391432
karcinomů527336001063375110145163204244298339
Současné34092002981302674055126387408791004
možnosti13929200298206344454595732833920985
adjuvantní2426920029812726833447259772286194610861150
léčby3625920029866191299441562
uroteliálních340118002981402303674545796457088338971036110012051345
karcinomů1733118002981302573464535186567939981135
Jindřich340158001374575140205247277327391
Kopecký1,7541580013767128194253303363423117615900803612101580013729
Alexandr12521580013772102160218276340405447
Poprach2172115800137641261922342923414062125159008036
1Klinika340174007833371174001336087111172197247301
onkologie6951740013361122173231257317379404459
a11771740013353
radioterapie,1254174001333689151175236271325361414475501556577
Fakultní18541740013354102153214239275335360
nemocnice22371740013361117208268318378403452505
Hradec27661740013371107160222277327
Králové3116174001335996149175235286340
2Klinika340189007833373189001336087111172197247301
komplexní6971890013352111202264290345397458483
onkologické12031890013360121172231257317379404453503557
péče,17831890013362118168221243
Masarykův20491890013388142184237273328379440492
onkologický25651890013360121172231257317379404453503558
ústav,31461890013361103140194244261
Brno3430189001336096157217
Uroteliální340240001216597151184234258281328352407430
karcinom791240001214696128172195251306389
(UC)1201240001212892150179
představuje1401240001215790139197236270318365421444495
závažný1916240001214393139188231287332
onkologický22692400012155110157211235290347370415461511
problém2801240001215790144202226276360
s31812400012140
vysokou3241240001214999139194241295350
mortalitou,36122400012183139171340254001213382105128161215271291
zejména658254001214393116200250306354
u10382540012155
pokročilých11202540012157113160194249294317340388432487
stadií.1633254001214073122179202225246
Adjuvantní19052540012161117141195244292348380435458
terapie,2390254001213382115164220244294314
ať2730254001214982
už2838254001215598
chemoterapie,2963254001214499150233289321371404452509532583603
nebo35922540012155106163219
imunoterapie,3402680012124109166223279313364398448506531583604
hraje973268001215790140165217
klíčovou121926800121487498144199248303360
roli1609268001213389114138
ve1777268001214999
snižování1906268001214097121165221270320377401
rizika2336268001213458102127175225
relapsu2591268001213385109159217258314
a29342680012150
zlepšení3013268001214468120179220271329353
přežití3395268001215892144188212247271
po36952680012158116
radikální340282001213383141166213264288345369
operaci.7382820012156115168202252298321343
Tento1110282001215196154187242
přehled1382282001215892143200225276335
shrnuje1747282001214097130188244268320
současné2097282001214097154200250290347398
poznatky25252820012158115158215265298346398
o29532820012156
využití30382820012149101158203227261285
adjuvantní33522820012150108132189238288345378435459
léčby340296001212475121178224
u5932960012155
UC6772960012165124
a8292960012149
uroteliálního906296001215689144177227251274322346402425483538
karcinomu1473296001214797130174197253309393448
horních19502960012156111145201224269325
cest2304296001214594134168
močových25012960012184140185240287338383438
(UTUC),2968296001212892143209268298316
včetně3313296001214892142176231282
jeho3624296001212475131187
histologických340310001215781121156212237294352377423471523568625
variant.995310001214999133157207264297319
Nejlépe13443100012167120145169221280333
etablovanou1707310001215185136195220277325375432489546
modalitou22833100012185142201251275299334389446
je2759310001212577
chemoterapie28663100012145102154240297331382416467525550601
na34973100012157107
bázi36333100012158109154178
cisplatiny,340324001214670110168193242276300357403420
která790324001214885135169219
prokázala1039324001215892148197248292344368417
přínos1486324001215892116173230271
zejména1786324001214495120205258315364
u21803240012156
pacientů22653240012159109155179230288321378
s26723240012140
vysokým27423240012149101142199248299386
rizikem3157324001213458102127175225311
relapsu3497324001213485110159217258314
(pT3–4,340338001212885129181233287308
N+)6683380012166124148
bez8363380012157108151
předchozí1008338001215789139196241296351393417
neoadjuvantní14453380012155106162210267291345394442498530585608
chemoterapie.2074338001214499150233289322371404452509532583603
Významný26973380012156104149205253336391437
průlom3154338001215790145168223307
přinesla3481338001215790114169219259282330
imunoterapie,3403520012123107161217272305354387435492516566586
zejména947352001214393117200250306354
nivolumab,1322352001215679127181205260343391448467
jehož1811352001212474130185227
účinnost20593520012155100123178234289328362
byla24423520012157103128176
potvrzena26393520012157113145196229274324380428
v30883520012148
randomizované3157352001213381137193248332355398453500548604654
studii340366001214073128185208231
CheckMate5953660012158113163209255338386419468
274,10873660012151100144164
přičemž1275366001215790113158207290333
největší16323660012156106130178227261301324
benefit19803660012157108164214244270303
byl23073660012157103127
pozorován24583660012157113155209242297344392448
u29293660012155
pacientů30083660012157106151174224279312366
s33983660012140
vysokou3461366001214999139194241295350
expresí340380001215097155188237277300
PD-L1.6643800012153118152201244260
Problematické948380001215385139196221271354403435458503549598
zůstává1570380001214398136170219266314
postavení19083800012157113152186235281330386409
adjuvantní23413800012148104128183231280335367423446
terapie2810380001213383115164221244294
u31283800012155
histologických3207380001215578117151205229284341364409455505549604
variant340394001214897129153200256288
UC,6463940012165123145
kde8103940012146102152
je980394001212575
potřeba10733940012157113146178228285334
dalšího14253940012156104128166189247302
výzkumu.1745394001214899144191246329384405
Budoucí21683940012154109166221277322344
směřování25313940012139122173204259306354410433
adjuvantní29823940012148105129183232280335368423446
léčby3446394001212474120176223
zahrnuje3687394001214392340408001215586141194217266
identifikaci623408001212378127181213235263289334382426448
prediktivních1088408001215688136192214260295317364419441485538
biomarkerů,1643408001215679133214261293339386418472492
včetně2152408001214890138170224273
ctDNA,2442408001214478143208267289
a27484080012147
vývoj2812408001214797147200223
personalizovaných30514080012156106138178231286333355377419472518566619664707760
strategií,340422001214073106155187236293316339360
které719422001214783132165215
zohlední953422001214398154177227285340363
molekulární13364220012183138162213260315339387419475498
a18534220012149
imunitní19214220012123107161217240273328351
charakteristiky22924220012145100148180229275311360393417456489512559609
nádoru.29214220012155103160215248303324
Optimalizace32654220012169126159182266314337360403453497546
selekce340436001214090114164212255304
pacientů6654360012157106151174224279312367
pomocí10524360012157113197252298321
tekutých1394436001213382129184218267311366
biopsií1781436001215781136193232255278
a20804360012148
dalších21494360012157105128167190234289
biomarkerů2459436001215781136220268300347396429484
je2964436001212475
klíčem306043600121477295139188272
ke3352436001214796
zlepšení3469436001214367117174213264319342
dlouhodobých340450001215680135190245301358413470516560615
výsledků.977450001214898138161211269315371391
Klíčová340466001246190118162220272325
slova:682466001244371129181234259
uroteliální959467001215587142175224248271318342396419
karcinom,1396467001214796129173196251306389410
karcinom1824467001214796128172195250305389
horních22314670012155110143199222266321
močových25704670012183138184237284335378433
cest,3021467001214594133167188
imunoterapie,32274670012123106161216271304353386434491514564584
chemoterapie.3404810012145100150234289322371404453509533583603
Current3405020012460116155193246306342
options7025020012458118156184242301345
for1067502001243492131
adjuvant12185020012453112141200253306365402
treatment1640502001243776129182219306360419456
of2116502001245792
urothelial2228502001245997156193253306334362415443
carcinomas2691502001244599137182211269327414467511
Urothelial340520001216597152185240290314337385409
carcinoma777520001214593126170193249304387436
(UC)1241520001212892150180
represents1449520001213383140173223262313368401441
a19195200012148
significant1995520001214063119174197227253298346402434
oncological24575200012155111156210234289346369414463486
challenge29715200012145100148172195245301357408
with3407520001217497130186
high3621520001215579135190
mortality,3405340012183138171207256279302335385401
particularly7595340012157106138174197241296319367400423471
in1248534001212378
advanced13445340012148105153202257302351408
stages.1770534001213973122178228268289
Adjuvant20775340012161117141195243292347379
therapy,2474534001213388139172220277323339
whether28315340012173129180213268318351
chemotherapy32005340012145100150234289322377427460508565611
or340548001215588
immunotherapy,4505480012123106189244300355387443493526574631677694
plays1165548001215781129175214
a14015480012148
crucial1471548001214577133178201249272
role1765548001213387111162
in1948548001212479
reducing2049548001213282140194239262317373
the2444548001213389139
risk260554800121325695141
of2768548001215584
relapse2874548001213382106154211250301
and31975480012148103160
improving33785480012124107164197251298322377434
survival340562001214094127178202250298322
after683562001214978114163196
radical901562001213281138161205254278
surgery.1200562001214094127182233266316332
This15545620012150106129168
review1744562001213282130154204277
summarises2043562001213994177260308341364403454493
current2558562001214599132165215270303
knowledge28825620012147104159232256306364420470
on33745620012155111
the3506562001213388139
use3667562001215594144
of340576001215584
adjuvant4475760012148105128183232280335368
treatment838576001213365115163196279329385417
in1278576001212479
UC13805760012165123
and15265760012148103160
upper17095760012155111169220253
tract1985576001213365114159194
urothelial2202576001215587142175230280304327375399
carcinoma2624576001214493125170193248303387435
(UTUC),3082576001212892142207266295314
including3419576001212378123146201258281336392
its34059000121235697
histological457590001215578117151205229284341364409457481
variants.958590001214896129152200255288328349
The13275900012150106157
most15045900012183138177211
established1735590001215090124172229253276315370420478
modality22335900012183138195243267290323373
remains2626590001213282166214237292331
cisplatin-based2977590001214467106163187235267290345378436484523574631
chemotherapy,362859000121451001503406040012183139171227277310358415461478
which8416040012173129152197252
has11166040012155103142
demonstrated12826040012156106190245301339373406454487536593
benefits,18986040012157109164215244271304344365
particularly22866040012157106139174197242297320368401425472
in2781604001212379
patients28836040012157105138161211267299340
at3246604001214880
high3350604001215578134189
risk356260400121335796142
of3727604001215584
relapse340618001213382106154210249299
(pT3–4,657618001212885128181231286306
N+)9816180012165123147
without1146618001217397129184239294327
prior1491618001215789113167200
neoadjuvant17096180012155105161209266289344392440495527
chemotherapy.2254618001214499149233288320375425458506562609625
A28976180012161
major29756180012184131155210242
breakthrough3235618001215790139187233269324356410465521576
has3406320012155103143
been5056320012156108159214
the741632001213388139
introduction902632001212379111143198255310355390413468524
of1448632001215584
immunotherapy,15546320012123106190244300355388443493526575631678694
especially2270632001215089146197243266313337360407
nivolumab,2699632001215679127181205260343391448468
whose31896320012173129184223274
efficacy3485632001215080112138183232277326
was3406460012174122161
confirmed522646001214599154183209242326376433
in977646001212378
the1076646001213389139
randomised1236646001213381137193248332355394444502
CheckMate17596460012158113163209255338386419468
27422486460012151100145
trial,241464600121336589137160181
with2616646001217397130185
the2822646001213389139
most29826460012184139178212
significant3215646001214062118174197226252297346401433
benefit366964600121571083406600012155105135161193
observed5516600012154111150200233283332389
in958660001212378
patients10536600012157105137160210265297337
with1408660001217397129184
high1610660001215578133188
PD-L118166600012152117151200242
expression.2076660001215097154186236275313336391446467
The25606600012150106156
role2733660001213387111161
of2911660001215584
adjuvant30126600012148104128182230278333365
therapy3395660001213287137170218274320
in3733660001212378
histological340674001215579117151205229284341364409458481
variants843674001214896129152200255288328
of1193674001215584
UC12986740012165123
remains1443674001213282166214237292331
unclear17956740012156111156179229277310
and21266740012149104160
requires2308674001213383140195218250300339
further2669674001212985118154209259292
research.2983674001213282122172220253297352373
The33786740012149106156
future3556674001212985118173205255
direction340688001215680112162207243266321376
of738688001215584
adjuvant8446880012148105129183232280335368
treatment1234688001213365115163196279329385417
involves1673688001212479125179203251300340
the2035688001213388138
identification2195688001212480130186218241271297342390423446501557
of2773688001215584
predictive2879688001215790140197220265300323372421
biomarkers,3321688001215781136220268300347396429469490
including340702001212379124147202259282337394
circulating762702001214568100145200223271304327382438
tumour1229702001213388171227282315
DNA15727020012167133194
(ctDNA)1794702001212970106172238299326
and21497020012148103160
developing23377020012157107155204228284341365420476
personalised28427020012157108141181237292340364387426476534
strategies3404702001214074106155188237294317367407
that340716001213388136169
consider536716001214598154193216272322355
the918716001213388139
molecular10847160012183139163213259313337385417
and15287160012148104160
immune17157160012124107190245300351
characteristics2093716001214499147180228273309358391414453487510555595
of2715716001215584
the2826716001213388139
tumour.2992716001213388171226282314330
Optimising33497160012169127160183266289328351406462
patient3407300012158108142165217274307
selection677730001214092117168215252275332389
using1095730001215697120177234
liquid1359730001212448105162186244
biopsies1632730001215882139197238262313354
and20157300012149106164
other2208730001215690147198232
biomarkers2470730001215882138224273307355405439481
is2980730001212464
key3073730001214898146
to3249730001213389
improving33677300012124109167201257306330387444
long-term340744001212479134190222256305338422
outcomes.7837440012155110143187241324375414436
Key3407600012461113164
words:5237600012476133171232276301
urothelial844761001215588142175230281305328375399
carcinoma,1262761001214594126170193248303387435456
upper17387610012155111169220253
tract2010761001213366114159194
urothelial2224761001215587142175230280304327375398
carcinoma,2642761001214593126170193248303387435456
immunotherapy,31177610012124107190245300355388443494527575632678694
chemotherapy.3407750012145100150234289322377427460509566612628
DECLARATIONS:4068242008648871301662142563043393604124625014570242008514
Declaration406825600874987120141179206244271291333375
of445725600874066
originality:45372560087406888130150192230251271298337356
The406826700853473109
manuscript418826700855891130168195227249266306329
is452826700851744
original45832670085386178117133172205222
and481626700853472112
has49392670085387299
not50502670085387699
been516126700853975110149
published532226700853977117134150177216251291
or406827800853862
submitted414527800852867108167184208234269310
elsewhere.44702780085355381117169209245269305320
Ethical406829200873764107127160198218
principles43002920087427090132165185228249287319
compliance:463329200873173134177197218256298330368387
The406830300853678116
authors420530300853475100142183208238
attest44643030085356087124153179
that466430300852465101126
their481130300852465103121146
study49783030085295595138173
was517230300855490119
approved531230300853577120145186221258301
by406831400854073
the41583140085236399
local42743140085175689124141
Ethical44323140085345898115147182199
Committee464831400854179139198215239265300337
and500231400853373113
is513231400851745
in519431400851656
compliance526731400853169129169187204239278311346
with40683250085537298140
human423632500854081143180221
studies44863250085285596139157195226
and474032500853577119
animal48883250085347695156193212
welfare512832500855391110133170196234
regulations53903250085236110414516420140683360085234080120148
of423533600853960
the43153360085236399
authors’44343360085347397136176200229244
institutions46983360085165684109126150189213231270310338
as505633600853462
well513833600855187104122
as527933600853462
with53613360085526993133
the55143360085236299
World406834700856099124142184
Medical427334700855795137155188224242
Association453534700854474104144178196231256273314355
Declaration491134700854785119136172196232257274315356
of528834700853961
Helsinki537034700854684102131149189224243
on406835800853878
Ethical41653580085355898115147182199
Principles43833580085376178117150167207225261290
for46923580085205983
Medical479435800855693134151183218235
Research504835800853874102139173197229268
Involving53353580085175690128146181198238278
Human406836900854685145179219
Subjects430736900853474114132168201227256
adopted458336900853474114155179215256
by485836900854074
the49523690085236399
18th507136900853669514136900501437
WMA5198369008559116160
General537836900854582122158182217235
Assembly406838000854475105143204247266302
in439338000851758
Helsinki,447438000854785104134152193228248264
Finland,47613800085355394113149190232249
in503338000851758
June511538000852667109147
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as486839100853462
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Recommendations406840200853977112153216278317359402439465483525568598
for46974020085226389
the481840200852466104
Conduct,495440200854283125168210245272290
Reporting,527540200853978121163189217236278321338
Editing,40684130085347491115132172212227
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2018,503742400853673107140156
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patient55164240085407540684350085234076116140
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where447543500855191127151187
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Conflict406844800874282124149171191223251
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interest44134480087196288126154192224251
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financial48144480087244587125167200220258279
disclosures:51074480087416293126147188220261289327359378
None.406846000854686126162177
Funding/Support:406847300873777119162183225267291329371414457499526554574
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