{"id":2295,"date":"2026-06-11T10:00:00","date_gmt":"2026-06-11T13:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2295"},"modified":"2026-06-11T10:00:00","modified_gmt":"2026-06-11T13:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-vesical-avancada-cistectomia-enfortumab-vedotin-pembrolizumab-sacituzumab-govitecan-trop-2","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-vesical-avancada-cistectomia-enfortumab-vedotin-pembrolizumab-sacituzumab-govitecan-trop-2\/","title":{"rendered":"PGRSS vesical avan: cistec, EV, pembro, SG"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica vesical avan\u00e7ada que reduzem PGRSS a descarte de Foley e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de cir oncol\u00f3gica vesical avan\u00e7ada metast\u00e1tica mUC<\/strong> + CRMI carcinoma urotelial m\u00fasculo-invasivo MIBC + NMIBC n\u00e3o-m\u00fasculo-invasivo high-risk<\/strong> + cistectomia radical+deriva\u00e7\u00e3o Hautmann\/Studer\/Indiana\/Bricker<\/strong> + BCG TICE+Connaught Lista C5 NMIBC<\/strong> + adjuvante nivolumab CheckMate-274 + neoadjuvante pembrolizumab+chemo NIAGARA+EV-103<\/strong> + enfortumab vedotin Padcev Pfizer\/Astellas Nectin-4 ADC + pembrolizumab Keytruda EV-302 1L<\/strong> + sacituzumab govitecan Trodelvy Gilead TROP-2 ADC TROPHY-U-01<\/strong> + erdafitinib Balversa Janssen FGFR3<\/strong> + disitamab vedotin Aidixi RemeGen HER2 ADC<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (mUC carcinoma urotelial+adeno+escamoso+pequenas c\u00e9lulas+sarcoma vesical raro+MIBC m\u00fasculo-invasivo+NMIBC high-risk Ta+T1+CIS) + Grupo A4 (linfa p\u00e9lvica obturador+il\u00edaca interna externa primitiva+presacral+ePLND extended pelvic lymph node dissection) + Grupo C (Iridium-192 brachy intersticial vesical raro + Y-90 SIRT met\u00e1stase hep\u00e1tica raro + Ra-223 met\u00e1stase \u00f3ssea raro) + Grupo E (perfuro TURBT ressectosc\u00f3pio Storz\/Wolf 24-26Fr + cistoscopia + bi\u00f3psia random+narrow band imaging NBI+Cysview hexaminolevulinate fluorescence + EUA examination) + Lista C5 (BCG TICE+Connaught+Tokyo cepas + cisplatina+gemcitabina GC + dose-dense MVAC ddMVAC + nivolumab Opdivo BMS CheckMate-274 1L adjuvante CRMI+CheckMate-901 1L mUC + pembrolizumab Keytruda Merck EV-302 1L mUC + KEYNOTE-866+KEYNOTE-A39 NIAGARA peri-op + atezolizumab Tecentriq IMvigor130\/210\/211 + durvalumab Imfinzi NIAGARA peri-op + avelumab Bavencio JAVELIN Bladder 100 maintenance + enfortumab vedotin Padcev Pfizer\/Astellas\/Seagen Nectin-4 ADC EV-301+EV-302+EV-103 + sacituzumab govitecan Trodelvy Gilead TROP-2 ADC TROPHY-U-01 + erdafitinib Balversa Janssen FGFR3 BLC2001+THOR + disitamab vedotin Aidixi RemeGen HER2 + nadofaragene firadenovec Adstiladrin Ferring NMIBC BCG-failure + N-803 Anktiva ImmunityBio NMIBC + pembrolizumab Keytruda KEYNOTE-057 NMIBC BCG-failure Lista C5).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de cir oncol\u00f3gica vesical avan\u00e7ada, \u00e9 fundamental dimensionar PGRSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos oncol\u00f3gicos vesicais avan\u00e7ados<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS vesical avan\u00e7ada tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
A1 mUC+MIBC+NMIBC<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nUrotelial 90%+CIS<\/td>\n<\/tr>\n
A4 cistec+deriva\u00e7\u00e3o<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nHautmann+Indiana+Bricker<\/td>\n<\/tr>\n
C brachy raro+Y-90<\/td>\n0,5-1,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nCNEN-NN-3.05<\/td>\n<\/tr>\n
E TURBT+cistoscopia<\/td>\n1-3 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nStorz+NBI+Cysview<\/td>\n<\/tr>\n
Lista C5 ADC+imuno<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nEV+SG+pembro+nivo<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 12-34 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica vesical avan\u00e7ada m\u00e9dia porte.<\/p>\n

A1 mUC + MIBC + NMIBC + biomarker FGFR3+Nectin-4+TROP-2+PD-L1+HER2: o est\u00e1gio cir\u00fargico+molecular<\/h2>\n

A primeira camada do PGRSS vesical avan\u00e7ada \u00e9 A1. Padr\u00e3o setorial inclui (a) mUC carcinoma urotelial metast\u00e1tico<\/strong> com 90% urotelial + adeno 2-3% + escamoso 5% + pequenas c\u00e9lulas 1-2% + variant histology micropapilar+plasmacytoid+sarcomatoide; (b) MIBC m\u00fasculo-invasivo T2-T4<\/strong> com tratamento padr\u00e3o neoadjuvante chemo + cistectomia radical + adjuvante imuno CheckMate-274 nivolumab DFS extension; (c) NMIBC n\u00e3o-m\u00fasculo-invasivo Ta+T1+CIS<\/strong> com TURBT + intravesical BCG TICE\/Connaught\/Tokyo + alternativa BCG-failure pembrolizumab KEYNOTE-057+nadofaragene firadenovec Adstiladrin Ferring+N-803 Anktiva ImmunityBio; (d) biomarker comprehensive molecular<\/strong> com FGFR3 mutation 15-20% + Nectin-4 universal expression + TROP-2 universal + HER2 amplification 5-10% + PD-L1 CPS\u226510 22C3 Dako+SP142 Ventana + MSI-H rare + TMB tumor mutational burden + comprehensive NGS FoundationOne CDx+Guardant360 ctDNA; (e) estadiamento TNM 8\u00aa<\/strong> Tis+Ta+T1+T2a-b+T3a-b+T4a-b+N0-N3+M0\/M1a-b + CID C67 + 4 escolas WHO 2016 + variant histology specific recommendations.<\/p>\n

Cl\u00ednica com A1 vesical avan\u00e7ada madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza biomarker FGFR3+Nectin-4+TROP-2+HER2+PD-L1 comprehensive<\/strong>. Como discutimos no post sobre vesical<\/a>, A1 vesical \u00e9 base.<\/p>\n

A4 cistectomia radical + deriva\u00e7\u00e3o + ePLND + neoadjuvante NIAGARA: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) cistectomia radical<\/strong> com bexiga + pr\u00f3stata + ves\u00edculas seminais (homem) + bexiga + \u00fatero + anexos + parede vaginal anterior (mulher) + ureteres distais + via aberta+laparosc\u00f3pica+rob\u00f3tica Da Vinci Xi+SP+Medtronic Hugo; (b) ePLND extended pelvic lymph node dissection<\/strong> com obturador + il\u00edaca interna externa primitiva + presacral + para-a\u00f3rtica at\u00e9 bifurca\u00e7\u00e3o a\u00f3rtica + 25-40 LN dissecados padr\u00e3o ouro Catalona; (c) deriva\u00e7\u00e3o urin\u00e1ria<\/strong> com neobexiga ortot\u00f3pica ileal Hautmann W-shape\/Studer U-shape\/Camey II + Indiana pouch heterot\u00f3pica continente + conduto ileal Bricker incontinente + escolha paciente+expertise; (d) neoadjuvante chemo cisplatina-based<\/strong> com cisplatina+gemcitabina GC + ddMVAC dose-dense methotrexate+vinblastine+doxorrubicina+cisplatina + downstaging 30-45% + OS gain meta-analysis; (e) peri-op imuno NIAGARA durvalumab+chemo+durva manuten\u00e7\u00e3o<\/strong> + KEYNOTE-866 pembrolizumab+chemo + EV-103 enfortumab+pembro neoadjuvante + adjuvante nivolumab CheckMate-274 OS extens\u00e3o.<\/p>\n

Cl\u00ednica com A4 cistectomia+deriva\u00e7\u00e3o+ePLND+NIAGARA madura escala R0 90+%<\/strong> + escala ePLND 25-40 LN padr\u00e3o ouro<\/strong> + escala NIAGARA OS extens\u00e3o peri-op imuno<\/strong>. Conex\u00e3o com vesical<\/a>.<\/p>\n

EV+pembro EV-302 1L + sacituzumab govitecan TROPHY-U-01 + erdafitinib THOR + disitamab vedotin: o est\u00e1gio sist\u00eamico+ADC+targeted<\/h2>\n

A terceira camada \u00e9 ADC+targeted+imuno. Padr\u00e3o setorial inclui (a) EV+pembro EV-302 1L mUC<\/strong> enfortumab vedotin Padcev Pfizer\/Astellas\/Seagen Nectin-4 ADC + pembrolizumab Keytruda Merck PD-1 + OS 31,5m vs 16,1m chemo HR 0,47 game-changer 1L mUC + EV-301 2L+ enfortumab single agent ORR 41% vs 18% chemo; (b) sacituzumab govitecan Trodelvy Gilead TROP-2 ADC topoisomerase I inhibitor SN-38<\/strong> TROPHY-U-01 2L+ ORR 27% + IMMU-132 + alternativa enfortumab; (c) erdafitinib Balversa Janssen FGFR3 mutation+fusion 2L+<\/strong> BLC2001+THOR 8mg PO QD + ORR 40% FGFR-altered + 15-20% mUC FGFR3-altered; (d) disitamab vedotin Aidixi RemeGen HER2 ADC<\/strong> RC48 + China approval + HER2 IHC 2+\/3+ + OS 7,9m vs chemo + ENGOT-cervical NCCN+ESMO recommendation; (e) outras mol\u00e9culas<\/strong> nivolumab Opdivo CheckMate-274 1L adjuvante CRMI DFS extens\u00e3o+CheckMate-901 1L mUC + atezolizumab Tecentriq IMvigor 130\/210\/211 + durvalumab Imfinzi NIAGARA peri-op + avelumab Bavencio JAVELIN Bladder 100 1L maintenance + pembrolizumab KEYNOTE-866+KEYNOTE-A39+KEYNOTE-057 NMIBC BCG-failure + nadofaragene Adstiladrin Ferring + N-803 Anktiva ImmunityBio Lista C5.<\/p>\n

Cl\u00ednica com EV+pembro+SG+erdafitinib+disitamab madura escala EV-302 OS 31,5m 1L mUC game-changer<\/strong> + escala TROPHY-U-01 ORR 27% TROP-2 2L+<\/strong> + escala THOR ORR 40% FGFR-altered<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

Tr\u00eas perfis de PGRSS por capacidade vesical avan\u00e7ada<\/h2>\n

Cl\u00ednica vesical avan s\u00f3 A1.<\/strong> 1 fluxo. Custo mensal R$ 9.000-26.000<\/strong> mas perda de A4+C+E+sist\u00eamico.<\/p>\n

Cl\u00ednica vesical avan A1 + A4 + GC.<\/strong> 3 fluxos. Custo mensal R$ 22.000-54.000<\/strong>, captura cirurgia + sist\u00eamico padr\u00e3o.<\/p>\n

Cl\u00ednica vesical avan 5 fluxos completos.<\/strong> A1+A4+C+E+sist\u00eamico + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 40.000-95.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura completa vesical avan\u00e7ada + EV+pembro EV-302 OS 31,5m 1L + TROPHY-U-01 + erdafitinib THOR + nadofaragene NMIBC.<\/p>\n

Os tr\u00eas erros que aparecem em cir oncol\u00f3gica vesical avan\u00e7ada<\/h2>\n

O primeiro \u00e9 a subdimensionamento Lista C5 ADC+imuno+targeted vesical<\/strong>. Sem segrega\u00e7\u00e3o BCG+cisplatina+gemcitabina+ddMVAC+nivolumab+pembrolizumab+atezolizumab+durvalumab+avelumab+enfortumab vedotin+sacituzumab govitecan+erdafitinib+disitamab vedotin+nadofaragene+N-803+ipilimumab + Lista C5 = n\u00e3o-conformidade ANVISA RDC 222 + risco contamina\u00e7\u00e3o cruzada profissional + impacto financeiro.<\/p>\n

O segundo \u00e9 a mistura A1 mUC + MIBC + NMIBC<\/strong>. Confunde rastreabilidade est\u00e1gio + impossibilita TNM 8\u00aa+CIS+variant histology + risco indica\u00e7\u00e3o inadequada (BCG NMIBC vs neoadjuvante chemo MIBC vs EV+pembro mUC).<\/p>\n

O terceiro \u00e9 a falta de protocolo biomarker FGFR3+Nectin-4+TROP-2+HER2+PD-L1 testing universal<\/strong>. Sem comprehensive NGS FoundationOne CDx+Guardant360 ctDNA + IHC PD-L1 22C3+SP142 + FGFR3 sequencing + HER2 IHC = perda elegibilidade ADC+targeted + zero precision medicine.<\/p>\n

A regula\u00e7\u00e3o de PGRSS vesical avan\u00e7ada no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com cir oncol\u00f3gica preservadora como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com PGRSS cl\u00ednicas especializadas<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A INCA C\u00e2ncer Bexiga<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS vesical avan\u00e7ada 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 mUC carcinoma urotelial 90%+adeno 2-3%+escamoso 5%+pequenas c\u00e9lulas+variant micropapilar+plasmacytoid+MIBC m\u00fasculo-invasivo T2-T4+NMIBC Ta+T1+CIS+FGFR3 mutation 15-20%+Nectin-4 universal+TROP-2 universal+HER2 5-10%+PD-L1 CPS\u226510 22C3 Dako+SP142+MSI-H+TMB+FoundationOne CDx+Guardant360+CID C67+TNM 8\u00aa, A4 cistectomia radical bexiga+pr\u00f3stata+ves\u00edculas+\u00fatero+anexos+parede vaginal+ureteres distais+aberta+laparosc\u00f3pica+rob\u00f3tica Da Vinci Xi+SP+Medtronic Hugo+ePLND obturador+il\u00edaca interna externa+presacral+para-a\u00f3rtica+25-40 LN Catalona+deriva\u00e7\u00e3o Hautmann W+Studer U+Camey II+Indiana pouch+Bricker conduto+neoadjuvante GC cisplatina+gemcitabina+ddMVAC dose-dense MVAC+downstaging 30-45%+NIAGARA durvalumab peri-op+KEYNOTE-866 pembro+EV-103 enfortumab+pembro, C Iridium-192 brachy raro+Y-90 SIRT raro+Ra-223 met\u00e1stase \u00f3ssea raro+CNEN-NN-3.05, E TURBT Storz 24-26Fr+Wolf+cistoscopia+NBI Narrow Band Imaging+Cysview hexaminolevulinate fluorescence+EUA examination+bi\u00f3psia random+selectiva, Lista C5 BCG TICE+Connaught+Tokyo+cisplatina+gemcitabina GC+ddMVAC+nivolumab Opdivo BMS CheckMate-274 adjuvante DFS+CheckMate-901 1L+pembrolizumab Keytruda Merck EV-302 1L OS 31,5m game-changer+KEYNOTE-866+KEYNOTE-A39 NIAGARA+atezolizumab Tecentriq IMvigor 130\/210\/211+durvalumab Imfinzi NIAGARA peri-op+avelumab Bavencio JAVELIN Bladder 100 maintenance+enfortumab vedotin Padcev Pfizer\/Astellas\/Seagen Nectin-4 ADC EV-301+EV-302+EV-103+sacituzumab govitecan Trodelvy Gilead TROP-2 ADC SN-38 TROPHY-U-01+erdafitinib Balversa Janssen FGFR3 BLC2001+THOR+disitamab vedotin Aidixi RemeGen HER2 ADC RC48+nadofaragene firadenovec Adstiladrin Ferring NMIBC BCG-failure+N-803 Anktiva ImmunityBio+pembrolizumab KEYNOTE-057.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS vesical avan\u00e7ada: cistec + enfortumab + pembro + sacituzumab. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2294,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,3132,3133,3131],"class_list":["post-2295","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-enfortumab","tag-sacituzumab","tag-vesical-avancada"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2295","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2295"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2295\/revisions"}],"predecessor-version":[{"id":4370,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2295\/revisions\/4370"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2294"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2295"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2295"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2295"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}