Bladder Cancer
Bladder Cancer
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DOI：
10.1007/978-3-030-28599-9_34
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Ó. Faba;J. D. Subiela;J. Palou
中科院分区：
文献类型：
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作者：
Ó. Faba;J. D. Subiela;J. Palou
大约75%的膀胱癌（BC）患者存在非肌肉浸润性疾病（NMIBC）。NMIBC代表了具有不同临床结局的异质性疾病。这些肿瘤从低级别到非常侵袭性的高级别疾病不等，显示出复发和进展的高风险。因此，早期诊断和准确的分层是必要的，以实现适当的治疗管理。TURBT是诊断、分期和治疗NMIBC的标准程序。TURBT后立即单次灌注化疗药物对BC复发有一定的有益作用，应考虑在低风险患者中使用。膀胱内BCG免疫疗法是中高危BC的标准疗法。对于具有其他不良预后因素的高级别T1肿瘤，应以风险适应的方式提供早期根治性化疗，以提高生存率并避免过度治疗的风险。肌肉浸润性膀胱癌（MIBC）占所有新诊断BC的25%。MIBC是一种侵袭性且危及生命的疾病，需要在高度专业化的中心进行及时管理。目前的治疗标准是新辅助化疗，然后是根治性化疗。然而，这两种治疗导致并发症和毒性的可能性很高。在精心选择的患者中采用膀胱保留方案可以获得可接受的肿瘤结局和良好的生活质量。实施新的分子标记物，使对化疗反应更好的患者更好地适应风险，新的成像技术以及微创和机器人手术的进步将在未来改善MIBC患者的生活质量和生存率。
Approximately 75% of Bladder Cancer (BC) patients present with a non-muscle invasive disease (NMIBC). NMIBC represents a heterogeneous disease with different clinical outcomes. These tumors vary from low-grade to very aggressive high-grade disease showing a high risk of recurrence and progression. Thus, an early diagnosis and accurate stratification is necessary to achieve an adequate therapeutic management. TURBT is the standard procedure for the diagnosis, staging, and treatment of NMIBC. The use of an single immediate instillation of a chemotherapy agent after TURBT has some beneficial effect on BC recurrence and it should be considered in low-risk patients. Intravesical BCG immunotherapy is standard therapy for intermediate- and high-risk BC. Early radical cystectomy should be offered in a risk-adapted manner in high-grade T1 tumors with other factors of poor prognosis to improve survival and avoid the risk of overtreatment. Muscle Invasive Bladder Cancer (MIBC) represents 25% of all new diagnosed BC. MIBC is an aggressive and life-threatening disease and requires timely management in highly specialized centers. The current standard of treatment is neoadjuvant chemotherapy followed by radical cystectomy. Nevertheless, both treatments result in a high probability of complications and toxicities. Bladder preservation protocols in well-selected patients can lead to acceptable oncological outcomes with a good quality of life. The implementation of novel molecular markers for a better risk adaptation of the patients who better respond to chemotherapy, the new imaging technologies and advances in minimally invasive and robotic surgery will improve in the next future the quality of life and survival of patients with MIBC.