Bevers Rob F M, Battermann Jan J, Gietema Jourik A, Hulsbergen-Van de Kaa Christina A, de Reijke Theo M, Feller Nicole, Witjes J A Fred
Leids Universitair Medisch Centrum, afd. Urologie, Leiden, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A956.
Urothelial carcinoma of the bladder is diagnosed predominantly in people over 60 years of age. The most common symptom is haematuria. Smoking is an important risk factor (relative risk 2.5 to 3). Cystoscopy is performed whenever bladder carcinoma is suspected. The recurrence rate of a non-muscle invasive urothelial carcinoma is high (31-78% within 5 years). A single intravesical instillation with a chemotherapeutic agent within 24 hours of transurethral resection (TUR) reduces the risk of recurrence. Carcinoma in situ (CIS) should be treated as high-grade urothelial carcinoma. Standard treatment for patients with non-metastasized muscle-invasive urothelial carcinoma is cystectomy in combination with extensive lymph node dissection. There are several possibilities for urinary diversion following cystectomy, none of which are any better than the others. Bladder-sparing brachytherapy may be used in patients with solitary T1 - T2 urothelial carcinoma < 5 cm. Neoadjuvant cisplatin-containing chemotherapy prior to cystectomy in muscle-invasive carcinoma only slightly improves survival. Cisplatin-containing combination chemotherapy is the standard treatment for metastasized urothelial carcinoma.
膀胱尿路上皮癌主要在60岁以上人群中被诊断出来。最常见的症状是血尿。吸烟是一个重要的风险因素（相对风险为2.5至3）。每当怀疑有膀胱癌时，都会进行膀胱镜检查。非肌层浸润性尿路上皮癌的复发率很高（5年内为31%-78%）。经尿道切除术（TUR）后24小时内单次膀胱内灌注化疗药物可降低复发风险。原位癌（CIS）应按高级别尿路上皮癌治疗。非转移性肌层浸润性尿路上皮癌患者的标准治疗方法是膀胱切除术联合广泛的淋巴结清扫术。膀胱切除术后有几种尿流改道的可能性，没有一种比其他的更好。膀胱保留近距离放射治疗可用于孤立性T1 - T2期尿路上皮癌<5 cm的患者。肌层浸润性癌患者在膀胱切除术前进行含顺铂的新辅助化疗仅能略微提高生存率。含顺铂的联合化疗是转移性尿路上皮癌的标准治疗方法。
