Bladder-conserving therapy for muscle invasive bladder cancer: current status and future
- Journal of Third Military Medical University Vol. 43, Issue 23, Pages: 2499-2506(2021)
- 作者机构：
400030 重庆，重庆大学附属肿瘤医院泌尿肿瘤科
- 作者简介：
- 基金信息：the Clinical Research Foundation of Chongqing Cancer Hospital (Non-registered)(JG-ZN-001-01);the General Program of Basic Research and Frontier Exploration of Chongqing Science and Technology Commission(cstc2018jcyjAX0781)
DOI：10.16016/j.1000-5404.202106149
CLC： R730.5;R737.14Received：19 June 2021，
Revised：2021-10-25，
Published：15 December 2021
- 稿件说明：
移动端阅览
Nan LIU, Fang YUAN. Bladder-conserving therapy for muscle invasive bladder cancer: current status and future[J]. Journal of Third Military Medical University, 2021, 43(23): 2499-2506.
Nan LIU, Fang YUAN. Bladder-conserving therapy for muscle invasive bladder cancer: current status and future[J]. Journal of Third Military Medical University, 2021, 43(23): 2499-2506. DOI： 10.16016/j.1000-5404.202106149.
摘要
根治性膀胱切除术加盆腔淋巴结清扫术是治疗肌层浸润性膀胱癌的金标准，但根治术创伤较大，严重内科合并症患者不能耐受手术，且术后近远期并发症发生率高。为获得良好膀胱癌控制效果，同时保留膀胱功能，维持良好的生活质量，国内外学者积极探讨保留膀胱的治疗方式。目前多采取经尿道最大限度膀胱肿瘤切除、化疗和外照射放疗的三联或多联综合治疗方式。其长期肿瘤控制效果与根治性膀胱切除术相当，也被国内外泌尿诊疗指南推荐作为肌层浸润性膀胱癌有效治疗选择。在保留膀胱综合治疗过程中，通过液体活检、影像学、膀胱镜活检或经尿道膀胱肿瘤切除的彻底性来评价其治疗效果，对反应差者可及时实施挽救性根治性切除术。另外，新辅助化疗对保留膀胱综合治疗患者的总生存率可能无影响，但可作为治疗反应性的筛选手段，反应欠佳者推荐早期行根治性切除术。目前国内尚无保留膀胱综合治疗的标准治疗方案，在最佳治疗人群的选择上尚难确定，其与膀胱根治性切除术疗效的随机对照研究、长期随访结果尚待观察。鉴于免疫检查点抑制剂在晚期尿路上皮癌治疗上取得的突破性疗效，在保留膀胱综合治疗中，免疫检查点抑制剂与放化疗联合的治疗或许将成为今后的研究方向。
Abstract
Radical cystectomy plus pelvic lymph node dissection is the gold standard treatment for muscle invasive bladder cancer. However
the patients with severe medical complications cannot tolerate the operation
and the incidence rates of short- and long-term postoperative complications are quite high. In order to achieve good tumor control while preserve bladder function and maintain good quality of life
bladder preservation treatment is actively explored in China and at abroad. At present
triple or multiple combination therapy
including maximum transurethral bladder tumor resection
chemotherapy and external irradiation and radiotherapy
is mostly adopted. Studies have shown that its long-term tumor control effect is similar to that of cystectomy
and it has been recommended as an effective treatment option for muscle invasive bladder cancer by domestic and foreign specialized diagnosis and treatment guidelines. In the course of comprehensive treatment for bladder preservation
the efficacy of the treatment is currently evaluated by liquid biopsy
radiography
cystoscopic biopsy or surgical thoroughness of transurethral bladder tumor resection
and timely salvage radical resection can be performed for the patients with poor response. In addition
neoadjuvant chemotherapy may have no effect on the overall survival of the patients after bladder preservation combination therapy
but it can be used as a screening method for treatment response
and early radical surgery is recommended for patients with poor response. There is no standard treatment plan for bladder preservation combination therapy
and it is difficult to determine the best treatment population. Randomized controlled studies and long-term follow-up trial of the combination treatment in comparison with radical bladder resection need to be carried out. In view of the breakthrough efficacy of immune checkpoint inhibitors in the treatment of advanced uroepithelial carcinoma
the combination of immune checkpoint inhibitors and radiotherapy and chemotherapy may also be the direction of future research.
关键词
Keywords
references
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