Bladder-sparing approaches for muscle invasive bladder cancer: a narrative review of current evidence and future perspectives.
Bladder-sparing approaches for muscle invasive bladder cancer: a narrative review of current evidence and future perspectives.
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DOI：
10.21037/tau-23-124
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发表时间：
2023-05-31
影响因子：
2
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近年来，微创“保留膀胱”三模式疗法（TMT）在某些不适合或拒绝根治性膀胱切除术（RC）的肌层浸润性膀胱癌（MIBC）患者中的应用不断增加。本综述旨在总结 MIBC 膀胱保留治疗的当前证据和未来前景。于 2022 年 7 月进行了非系统性 Medline/PubMed 文献检索，检索关键词为“MIBC”、“膀胱保留”、“化疗”、“放射治疗”、“三模式”、“多模式”和“免疫治疗”。所有单一疗法均不如 RC 或联合疗法，不应常规用于治疗目的。与放化疗相比，单独放疗（RT）已被证明效果较差。 TMT 的理想选择标准包括良好的膀胱功能和容量、cT2 内的临床分期、经尿道膀胱肿瘤完全切除术 (TURBT)、既往无盆腔放疗史、无广泛性原位癌 (CIS) 和无肾积水。免疫疗法的出现可能会进一步增强膀胱保留疗法的效果。新型预测生物标志物有望实现更精确的患者选择和更好的肿瘤学结果。 TMT 具有良好的耐受性，为选定的局部 MIBC 患者提供了一种替代 RC 的治疗方法。适当的患者选择和多学科方法对于通过膀胱保留治疗实现良好的肿瘤控制至关重要。
In recent years, the application of less-invasive “bladder-sparing” trimodal therapy (TMT) in selected muscle-invasive bladder cancer (MIBC) patients unfit for or who declined radical cystectomy (RC) has been increasing. This review aims to summarize the current evidence and future perspectives of bladder-sparing therapy for MIBC. A non-systematic Medline/PubMed literature search was conducted on July 2022 with the following keywords ‘MIBC’, ‘bladder-sparing’, ‘chemotherapy’, ‘radiotherapy’, ‘trimodal’, ‘multimodal’, and ‘immunotherapy’. All monotherapies are inferior to RC or combination therapy and should not be routinely used for curative intent. Radiotherapy (RT) alone has been shown to have poorer outcomes when compared to chemoradiotherapy. The ideal selection criteria for TMT include good bladder function and capacity, clinical stage within cT2, complete transurethral resection of bladder tumor (TURBT), no prior history of pelvic RT, no extensive carcinoma in situ (CIS), and absence of hydronephrosis. The emergence of immunotherapy may further increase the effect of bladder-sparing therapy. Novel predictive biomarkers are awaited for more precise patient selection and better oncological outcomes. TMT is a well-tolerated and offers a curative alternative approach to RC for selected patients with localized MIBC. Appropriate patient selection and a multi-disciplinary approach is crucial in achieving good oncologic control with bladder-sparing therapy.