Department of Urology, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
Nat Rev Urol. 2017 Sep;14(9):565-574. doi: 10.1038/nrurol.2017.82. Epub 2017 Jul 4.
Muscle-invasive bladder cancer is an aggressive disease associated with high morbidity and mortality. Radical cystectomy is the mainstay of treatment and has evolved since the first reported cystectomy in 1887 to include pelvic lymph node dissection and the creation of increasingly sophisticated urinary diversions, such as neobladders and pouches, which enable patients to maintain continence. Pioneering work in the 1970s established the therapeutic activity of cisplatin in patients with bladder cancer and resulted in the introduction of cisplatin-based neoadjuvant chemotherapy, which led to the first improvement in survival outcomes in decades. Other notable advances include the development of bladder-sparing protocols, which combine surgery, chemotherapy, and radiotherapy. Molecular profiling of bladder cancer has helped to enhance our understanding of tumour biology and identify several therapeutic targets, such as programmed death (PD-1) and its ligand programmed cell death ligand 1 (PD-L1). Over the past 3 years, immune checkpoint inhibitors targeting the PD-1-PD-L1 axis have demonstrated the ability to achieve durable objective responses in trials of patients with metastatic disease. If the current momentum continues, immunotherapy is poised to change the landscape of muscle-invasive bladder cancer treatment, promising improved survival outcomes for patients with this disease.
肌层浸润性膀胱癌是一种侵袭性疾病，具有较高的发病率和死亡率。根治性膀胱切除术是主要的治疗方法，自 1887 年首次报道以来，已经发展到包括盆腔淋巴结清扫术和创建日益复杂的尿流改道术，如新膀胱和袋状结构，使患者能够保持控尿能力。20 世纪 70 年代的开创性工作确立了顺铂在膀胱癌患者中的治疗活性，并导致顺铂为基础的新辅助化疗的引入，这导致了几十年来首次改善生存结果。其他显著进展包括保留膀胱方案的发展，这些方案结合了手术、化疗和放疗。膀胱癌的分子谱分析有助于增强我们对肿瘤生物学的理解，并确定了几个治疗靶点，如程序性死亡 (PD-1) 及其配体程序性细胞死亡配体 1 (PD-L1)。在过去的 3 年中，针对 PD-1-PD-L1 轴的免疫检查点抑制剂在转移性疾病患者的试验中证明了能够实现持久的客观反应。如果目前的势头持续下去，免疫疗法有望改变肌层浸润性膀胱癌治疗的格局，有望为患有这种疾病的患者带来更好的生存结果。
