肌层浸润性膀胱癌保留膀胱综合治疗的现状和未来

刘南; 袁方

doi:10.16016/j.1000-5404.202106149

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肌层浸润性膀胱癌保留膀胱综合治疗的现状和未来

专题报道：膀胱癌基础与临床研究 | 更新时间：2026-01-09

- 肌层浸润性膀胱癌保留膀胱综合治疗的现状和未来
- Bladder-conserving therapy for muscle invasive bladder cancer: current status and future
- 第三军医大学学报 2021年43卷第23期页码：2499-2506
- 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：
  
  [刘南，博士，主任医师，硕士研究生导师，德国图宾根大学医学院访问学者。担任中国抗癌协会泌尿男生殖系肿瘤专委会常委，中国临床肿瘤学会前列腺癌专家委员会常委，中国抗癌协会男生殖系肿瘤专业委员会少见类型肾癌协作组顾问团顾问，中国肿瘤医院泌尿肿瘤协作组(UCOG)委员，重庆市医学会泌尿外科学专业委员会副主任委员，重庆市医学会泌尿外科学专业委员会肿瘤学组副组长，重庆市中西医结合学会泌尿外科专业委员会副主任委员。主持重庆市适宜技术推广项目2项，参研国家自然科学基金面上项目2项，参加国内外30多项GCP研究，参与编写指南共识9篇。主要从事泌尿肿瘤规范化和多学科诊疗方面的研究。E-mail: 1054567372@qq.comLIU Nan, E-mail: 1054567372@qq.com
- 基金信息：
  
  重庆市肿瘤医院临床研究(非注册类)(JG-ZN-001-01);重庆市科委基础研究与前沿探索一般项目(cstc2018jcyjAX0781)
- DOI：10.16016/j.1000-5404.202106149
  中图分类号： R730.5;R737.14
- 收稿：2021-06-19，
  
  修回：2021-10-25，
  
  纸质出版：2021-12-15
- 稿件说明：
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刘南, 袁方. 肌层浸润性膀胱癌保留膀胱综合治疗的现状和未来[J]. 第三军医大学学报, 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.
刘南, 袁方. 肌层浸润性膀胱癌保留膀胱综合治疗的现状和未来[J]. 第三军医大学学报, 2021,43(23):2499-2506. DOI： 10.16016/j.1000-5404.202106149.

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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