Azzouz H, Cauberg E C C, De Reijke Th M
Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands.
Minerva Urol Nefrol. 2011 Dec;63(4):309-15.
T1 urothelial bladder cancers are in majority high-grade and seem to grow rapidly with the potential not only to recur, but also to progress to muscle invasion. Therefore, management discussions for patients with a high-grade T1 urothelial bladder cancer are critical. In this review, we aim to give an overview of the controversies encountered in the management of these tumors. Relevant information on T1 urothelial cell bladder cancer was identified through a literature search of published studies and review articles. Establishing an accurate diagnosis is of utmost importance in T1 bladder cancer; particularly understaging can adversely impact the survival of the patient. Therefore, a standard re-TUR is highly recommended in all T1 bladder cancer patients. On the other hand overtreatment affects the quality of life and can lead to unnecessary morbidity. The available treatment options range widely: they include transurethral resection alone with or without re-resection, adding intravesical therapy, radical cystectomy, and bladder sparing techniques using radiotherapy or combined chemoradiation. The choice and timing of the decision whether to pursue with conservative management (TUR and BCG) or to proceed with cystectomy (selected cases with adverse prognostic factors) should be continuously reconsidered on an individual patient basis. This is why the decision making is so difficult, and although we have come along a way in understanding the biological behavior of these tumors, both the choice and timing of treatment remain controversial. After ensuring that accurate staging has been done, the therapeutic options for T1 bladder tumors vary widely (from bladder sparing approaches to cystectomy) and a choice should be made based on individual patient basis.
T1期膀胱尿路上皮癌大多为高级别，似乎生长迅速，不仅有复发的可能，还可能进展为肌层浸润。因此，对于高级别T1期膀胱尿路上皮癌患者的治疗讨论至关重要。在本综述中，我们旨在概述这些肿瘤治疗中遇到的争议。通过检索已发表的研究和综述文章，确定了关于T1期膀胱尿路上皮癌的相关信息。在T1期膀胱癌中，准确诊断至关重要；尤其是分期过低会对患者的生存产生不利影响。因此，强烈建议所有T1期膀胱癌患者进行标准的再次经尿道膀胱肿瘤切除术（re-TUR）。另一方面，过度治疗会影响生活质量，并可能导致不必要的发病率。现有的治疗选择范围广泛：包括单纯经尿道切除术（有或无再次切除）、联合膀胱内灌注治疗、根治性膀胱切除术以及使用放疗或放化疗联合的膀胱保留技术。对于是采用保守治疗（TUR和卡介苗灌注）还是进行膀胱切除术（有不良预后因素的特定病例）的决策选择和时机，应根据每个患者的情况不断重新考虑。这就是为什么决策如此困难，尽管我们在理解这些肿瘤的生物学行为方面已经取得了一定进展，但治疗的选择和时机仍然存在争议。在确保已进行准确分期后，T1期膀胱肿瘤的治疗选择差异很大（从膀胱保留方法到膀胱切除术），应根据每个患者的情况做出选择。
