Milowsky Matthew I, Stadler Walter M, Bajorin Dean F
Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2008 Nov;102(9 Pt B):1339-44. doi: 10.1111/j.1464-410X.2008.07980.x.
Bladder cancer is a potentially curable malignancy but for those patients who present with or develop muscle-invasive disease, there is a high risk of metastases and cancer-related death. The treatment of patients with muscle-invasive bladder cancer uses a multimodal approach, including radical cystectomy with pelvic lymph node dissection and perioperative chemotherapy. Neoadjuvant cisplatin combination chemotherapy has a modest survival benefit, with those patients achieving a complete pathological response after chemotherapy having the best outcome. Adjuvant chemotherapy, although less well substantiated, is a reasonable option for patients with extravesical disease or lymph node involvement after cystectomy. Perioperative chemotherapy is substantially underused despite the level-1 evidence showing a survival benefit. Ongoing research will focus on individualized patient care, with biomarkers to predict a pathological complete response and the development of novel targeted therapies.
膀胱癌是一种潜在可治愈的恶性肿瘤，但对于那些出现或发展为肌肉浸润性疾病的患者，发生转移和癌症相关死亡的风险很高。肌肉浸润性膀胱癌患者的治疗采用多模式方法，包括根治性膀胱切除术加盆腔淋巴结清扫术和围手术期化疗。新辅助顺铂联合化疗有一定的生存获益，化疗后达到完全病理缓解的患者预后最佳。辅助化疗虽然证据不足，但对于膀胱切除术后有膀胱外疾病或淋巴结受累的患者是一种合理的选择。尽管一级证据表明围手术期化疗有生存获益，但该疗法的使用仍严重不足。正在进行的研究将聚焦于个体化患者护理，寻找预测病理完全缓解的生物标志物以及开发新型靶向疗法。
