Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, Barcelona, Spain.
Minerva Med. 2013 Jun;104(3):273-86.
Despite standard treatment with transurethral resection (TURBT) and adjuvant therapy, many bladder cancers (BCs) recur and some progress. Based on a review of the literature, we aimed to establish the optimal current approach for the early diagnosis and management of non-muscle-invasive bladder cancer (NMIBC).
A Medline® search was conducted to identify the published literature relating to early identification and treatment of NMIBC. Particular attention was paid to factors such as quality of TURBT, importance of second TUR, substaging, and carcinoma in situ. In addition, studies on urinary markers, photodynamic diagnosis, predictive clinical and molecular factors for recurrence and progression after BCG, and best management practice were analyzed.
Good quality of TUR and the implementation of photodynamic diagnosis in selected cases provide a more accurate diagnosis and reduce the risk of residual tumor in bladder cancer. Although insufficient evidence is available to warrant the use of new urinary molecular markers in isolation, their use in conjunction with cytology and cystoscopy can improve early diagnosis and follow-up. BCG plus maintenance for at least one year remains the standard adjuvant treatment in high-risk BC. Moreover, there is enough evidence to consider the implementation of new specific risk tables for patients treated with BCG.
In high-risk patients with poor prognostic factors after TUR, early cystectomy should be considered.
尽管采用经尿道膀胱肿瘤切除术（TURBT）和辅助治疗，许多膀胱癌（BC）仍会复发，有些还会进展。基于对文献的回顾，我们旨在确定早期诊断和治疗非肌肉浸润性膀胱癌（NMIBC）的最佳当前方法。
通过 Medline®搜索，确定与 NMIBC 的早期识别和治疗相关的已发表文献。特别关注 TURBT 的质量、二次 TUR 的重要性、亚分期和原位癌等因素。此外，还分析了尿标志物、光动力诊断、BCG 后复发和进展的预测临床和分子因素以及最佳管理实践。
良好的 TUR 质量和在选定病例中实施光动力诊断可提供更准确的诊断并降低膀胱癌中残留肿瘤的风险。尽管没有足够的证据支持单独使用新的尿分子标志物，但将其与细胞学和膀胱镜检查结合使用可以改善早期诊断和随访。BCG 加维持治疗至少一年仍然是高危 BC 的标准辅助治疗。此外，有足够的证据表明，可以考虑为接受 BCG 治疗的患者实施新的特定风险表。
对于 TUR 后预后不良因素的高危患者，应考虑早期行膀胱切除术。
