From the aDepartment of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and bDepartment of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Natl Compr Canc Netw. 2013 Aug;11(8):952-60. doi: 10.6004/jnccn.2013.0116.
Potentially curative treatments for patients with muscle-invasive bladder cancer (MIBC) are underused, especially in the elderly. Trimodality bladder preservation therapy, which includes a maximally safe transurethral resection of the bladder tumor, followed by concurrent chemoradiation, fulfills this currently unmet need. In multiple prospective clinical trials and large institutional series, trimodality therapy has demonstrated excellent 5-year overall survival rates of 48% to 65%, comparable to those reported in cystectomy studies. Approximately 75% to 80% of long-term survivors maintain their native bladders, which tend to function well and allow patients to maintain excellent quality of life. Salvage cystectomy for patients who develop a local invasive recurrence can be performed with acceptable operative complication rates, and results in excellent long-term disease control and survival outcomes. For patients with MIBC who are noncystectomy candidates, or select patients who are motivated to keep their native bladders, trimodality bladder preservation therapy is recognized by the International Consultation on Urological Diseases-European Association of Urology and the NCCN Clinical Practice Guidelines in Oncology for Bladder Cancer as an effective alternative to radical cystectomy, and should be considered. In the future, biomarkers may allow improved selection of patients for whom trimodality bladder preservation therapy is most likely to succeed.
根治性膀胱切除术治疗肌层浸润性膀胱癌（MIBC）效果显著，但目前该疗法的使用率较低，尤其是在老年患者中。三联疗法（最大限度安全的经尿道膀胱肿瘤切除术，同步放化疗）可满足目前尚未满足的需求。多项前瞻性临床试验和大型机构系列研究表明，三联疗法的 5 年总生存率高达 48%至 65%，与膀胱切除术研究报告的结果相当。约 75%至 80%的长期幸存者保留了其原生膀胱，这些膀胱功能良好，使患者保持了良好的生活质量。对于出现局部侵袭性复发的患者，可以进行挽救性膀胱切除术，其手术并发症发生率可接受，并且可以获得极佳的长期疾病控制和生存结果。对于不适合行根治性膀胱切除术的 MIBC 患者，或有意愿保留原生膀胱的特定患者，国际尿控协会-欧洲泌尿外科学会和 NCCN 肿瘤学临床实践指南均认可三联疗法作为根治性膀胱切除术的有效替代方案，应当考虑采用该疗法。未来，生物标志物可能有助于更好地选择最有可能成功接受三联疗法的患者。
