Department of Urology, UT Southwestern Medical Center at Dallas, Moss Building, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9110, USA.
Centre of Postgraduate Medical Education, Warsaw, Poland.
Nat Rev Dis Primers. 2017 Apr 13;3:17022. doi: 10.1038/nrdp.2017.22.
Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality and cost. Environmental or occupational exposures to carcinogens, especially tobacco, are the main risk factors for bladder cancer. Most bladder cancers are diagnosed after patients present with macroscopic haematuria, and cases are confirmed after transurethral resection of bladder tumour (TURBT), which also serves as the first stage of treatment. Bladder cancer develops via two distinct pathways, giving rise to non-muscle-invasive papillary tumours and non-papillary (solid) muscle-invasive tumours. The two subtypes have unique pathological features and different molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers of muscle-invasive bladder cancer (MIBC) as well as subtypes of MIBC with distinct characteristics and therapeutic responses. For non-muscle-invasive bladder cancer (NMIBC), intravesical therapies (primarily Bacillus Calmette-Guérin (BCG)) with maintenance are the main treatments to prevent recurrence and progression after initial TURBT; additional therapies are needed for those who do not respond to BCG. For localized MIBC, optimizing care and reducing morbidity following cystectomy are important goals. In metastatic disease, advances in our genetic understanding of bladder cancer and in immunotherapy are being translated into new therapies.
膀胱癌是一种高发疾病，与较高的发病率、死亡率和医疗成本相关。环境或职业暴露于致癌物，尤其是烟草，是膀胱癌的主要危险因素。大多数膀胱癌是在患者出现肉眼血尿后诊断出来的，通过经尿道膀胱肿瘤切除术（TURBT）确诊，TURBT 也是治疗的第一阶段。膀胱癌通过两种不同的途径发展，导致非肌肉浸润性乳头状肿瘤和非乳头状（实体）肌肉浸润性肿瘤。这两种亚型具有独特的病理特征和不同的分子特征。事实上，癌症基因组图谱项目确定了肌肉浸润性膀胱癌（MIBC）的遗传驱动因素，以及具有不同特征和治疗反应的 MIBC 亚型。对于非肌肉浸润性膀胱癌（NMIBC），膀胱内治疗（主要是卡介苗（BCG））联合维持治疗是预防初始 TURBT 后复发和进展的主要治疗方法；对于那些对 BCG 无反应的患者，需要额外的治疗。对于局限性 MIBC，优化膀胱切除术的护理并降低发病率是重要目标。在转移性疾病中，我们对膀胱癌遗传的理解的进步和免疫疗法正在转化为新的治疗方法。
