Gakis G, Stenzl A, Horn T, Gschwend J E, Otto W, Burger M
Klinik und Poliklinik für Urologie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland.
Urologe A. 2015 Apr;54(4):491-8. doi: 10.1007/s00120-015-3774-7.
Non-muscle-invasive bladder cancer with a low-grade differentiation represents a special challenge.
Although urine cytology is still the most reliable and effective urine-based marker and there are no substantial novel aspects in this field, photodynamic diagnostics have the most important value in transurethral resection of the bladder (TURB) of high-grade T1 tumors and new techniques, such as hybrid knife TURB are coming up. The histopathological assessment of T1 tumors can be supplemented by a description of the exact penetration depth, so-called substaging and the invasion pattern.
Intravesicle therapy with Bacillus Calmette-Guèrin (BCG) represents the gold standard and a pillar of bladder-preserving therapy and should be planned as maintenance therapy for at least 1 year. With the right risk constellation cystectomy is a safe and proven concept for high-grade bladder cancer, even without proof of muscle invasion.
低级别分化的非肌层浸润性膀胱癌是一项特殊挑战。
尽管尿细胞学检查仍是最可靠且有效的基于尿液的标志物，且该领域并无实质性新进展，但光动力诊断在高级别T1肿瘤的经尿道膀胱肿瘤切除术（TURB）中具有最重要价值，诸如混合刀TURB等新技术也不断涌现。T1肿瘤的组织病理学评估可通过描述确切的浸润深度（即所谓的亚分期）和浸润模式来补充。
卡介苗（BCG）膀胱内灌注治疗是膀胱保留治疗的金标准和支柱，应计划作为维持治疗至少1年。对于高级别膀胱癌，即使没有肌层浸润的证据，在合适的风险组合下，膀胱切除术也是一种安全且经证实的方案。
