Malkowicz S Bruce, van Poppel Hendrik, Mickisch Gerald, Pansadoro Vito, Thüroff Joachim, Soloway Mark S, Chang Sam, Benson Mitchell, Fukui Iwao
Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Urology. 2007 Jan;69(1 Suppl):3-16. doi: 10.1016/j.urology.2006.10.040.
Muscle-invasive urothelial (transitional cell) carcinoma is a potentially lethal condition for which an attempt at curative surgery is required. Clinical staging does not allow for accurate determination of eventual pathologic status. Muscle-invasive urothelial carcinoma is a highly progressive disease, and initiation of definitive therapy within 3 months of diagnosis is worthwhile. Age is not a contraindication for aggressive surgical care, and surgical candidates should be evaluated in the context of overall medical comorbidity. In those patients who undergo surgery, clinical pathways may streamline care. Radical cystectomy remains the "gold standard" of therapy, providing 5-year survival rates of 75% to 80% in patients with organ-confined disease, yet organ-sparing procedures demonstrate clinical effectiveness as well. Cystectomy should be undertaken with the intent of performing complete pelvic lymph node dissection and attaining surgically negative margins. In younger female patients, the preservation of reproductive organs may be achieved in many cases. Prostate- and seminal vesicle-preserving cystectomy has been performed, yet the long-term safety and efficacy of such a procedure remains to be determined. Laparoscopic and robotic cystectomy procedures continue to be explored by several investigators. The role of "radical transurethral resection" in muscle-invasive disease is limited to a small cohort of patients, and, when it is performed, cystectomy may be required to consolidate therapy. Postoperative follow-up after cystectomy should occur over short intervals during the first 2 years and can be extended, but not discontinued, beyond that time. Currently, no tumor markers have been prospectively validated to help guide clinical decision making, and prospective trials incorporating marker data should be encouraged.
肌层浸润性尿路上皮（移行细胞）癌是一种潜在致命性疾病，需要尝试进行根治性手术。临床分期无法准确确定最终的病理状态。肌层浸润性尿路上皮癌是一种高度进展性疾病，在诊断后3个月内开始确定性治疗是值得的。年龄并非积极手术治疗的禁忌证，手术候选者应在整体合并症的背景下进行评估。对于接受手术的患者，临床路径可简化治疗。根治性膀胱切除术仍然是治疗的“金标准”，对于器官局限性疾病患者，其5年生存率为75%至80%，但保留器官的手术也显示出临床有效性。膀胱切除术应旨在进行完整的盆腔淋巴结清扫并获得手术切缘阴性。在年轻女性患者中，在许多情况下可实现生殖器官的保留。已开展保留前列腺和精囊的膀胱切除术，但其长期安全性和有效性仍有待确定。一些研究人员仍在探索腹腔镜和机器人辅助膀胱切除术。“根治性经尿道切除术”在肌层浸润性疾病中的作用仅限于一小部分患者，并且在进行该手术时，可能需要膀胱切除术来巩固治疗。膀胱切除术后的随访应在术后前2年进行短间隔随访，之后可延长但不能中断。目前，尚无肿瘤标志物经过前瞻性验证以帮助指导临床决策，应鼓励开展纳入标志物数据的前瞻性试验。
