Clark Peter E
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
Curr Opin Oncol. 2007 May;19(3):241-7. doi: 10.1097/CCO.0b013e3280ad43ac.
This article reviews the diagnosis and management of bladder cancer with an emphasis on studies and developments over the past year.
Cystoscopy remains the mainstay in the detection and surveillance of bladder cancer, though efforts continue in the development of urinary bladder cancer markers. Superficial bladder cancer continues to be managed predominantly through transurethral resection with perioperative instillation of chemotherapy recommended for most patients. Intravesical bacille Calmette-Guerin (including a maintenance regimen) should be used for those at high risk for progression. Muscle invasive disease continues to be managed by radical cystectomy. Research continues on the use of laparoscopy, the effect on patient's health-related quality of life, and the potential role for bladder preservation strategies. The role of neoadjuvant versus adjuvant chemotherapy around the time of cystectomy remains to be resolved. The mainstays of chemotherapy remain methotrexate, vinblastine, doxorubicin, and cisplatin, and gemcitabine and cisplatin, but work is ongoing to develop new regimens, especially in patients who cannot take cisplatin.
Although great strides continue to be made each year in the diagnosis and management of bladder cancer considerably more work needs to be done in order to improve the lives of our patients with this disease.
本文回顾了膀胱癌的诊断与治疗，重点关注过去一年的研究与进展。
膀胱镜检查仍是膀胱癌检测与监测的主要手段，不过膀胱癌标志物的研发工作仍在继续。浅表性膀胱癌主要通过经尿道切除术进行治疗，大多数患者建议围手术期进行化疗灌注。对于进展风险高的患者，应使用膀胱内卡介苗（包括维持方案）。肌层浸润性疾病仍通过根治性膀胱切除术进行治疗。腹腔镜的应用、对患者健康相关生活质量的影响以及膀胱保留策略的潜在作用等方面的研究仍在继续。膀胱切除术前后新辅助化疗与辅助化疗的作用仍有待确定。化疗的主要药物仍是甲氨蝶呤、长春碱、阿霉素和顺铂，以及吉西他滨和顺铂，但正在开展新方案的研发工作，尤其是针对无法使用顺铂的患者。
尽管每年在膀胱癌的诊断和治疗方面都取得了巨大进展，但为了改善膀胱癌患者的生活，仍有大量工作要做。
