Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Curr Opin Oncol. 2010 May;22(3):242-9. doi: 10.1097/CCO.0b013e3283378c6b.
To review the diagnosis and management of all stages of bladder cancer with an emphasis on studies and developments within the last year.
Cystoscopy remains the gold standard for diagnosis of bladder tumors, though fluorescent light and urinary biomarkers can both improve the sensitivity of cancer detection. Management of high-risk patients with nonmuscle invasive cancer continues to be controversial, with a number of risk assessment tools developed to help stratify patients to cystectomy or bladder-sparing regimens. Intravesical therapy is utilized both as a one-time perioperative regimen and as a weekly regimen, and research continues in the development of agents for bacillus Calmette-Guerin-refractory superficial bladder cancer. In patients undergoing cystectomy, evidence supports the need for an adequate lymphadenectomy. Although there are limited data on robotic assisted radical cystectomy, initial reports suggest that an appropriate lymph node dissection can be performed. The role of bladder-sparing modalities as well as the use of adjuvant and neoadjuvant therapies is still debated. Trials investigating these therapies continue to seek to improve both oncologic outcomes and quality of life for patients with invasive bladder cancer.
Progress continues in bladder cancer diagnosis and management, and we anticipate that future work will further advance the care of patients with this disease.
综述膀胱癌各阶段的诊断和治疗，重点介绍过去一年的研究进展。
膀胱镜检查仍然是诊断膀胱肿瘤的金标准，尽管荧光检查和尿液生物标志物都可以提高癌症检测的灵敏度。对于非肌肉浸润性膀胱癌的高危患者，其治疗方案仍存在争议，目前已开发出许多风险评估工具，以帮助将患者分层为行膀胱切除术或膀胱保留治疗方案。膀胱内治疗既可以作为一次性围手术期治疗方案，也可以作为每周治疗方案，并且正在继续研究用于治疗卡介苗耐药的表浅膀胱癌的药物。对于接受膀胱切除术的患者，有证据支持需要进行充分的淋巴结清扫。尽管机器人辅助根治性膀胱切除术的数据有限，但初步报告表明可以进行适当的淋巴结清扫。膀胱保留治疗方法以及辅助和新辅助治疗的应用仍存在争议。正在进行的临床试验继续寻求改善浸润性膀胱癌患者的肿瘤学治疗效果和生活质量。
膀胱癌的诊断和治疗仍在不断发展，我们预计未来的研究将进一步提高患者的治疗效果。
