Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
World J Urol. 2019 Sep;37(9):1767-1772. doi: 10.1007/s00345-018-2480-7. Epub 2018 Sep 14.
Patients with localized muscle-invasive bladder cancer (MIBC) can choose to undergo either neoadjuvant chemotherapy followed by radical cystectomy or radiation therapy-based bladder preservation treatment modality with subsequent close cystoscopic surveillance with salvage cystectomy reserved for patients with evidence of local disease recurrence. At the present time, the decision regarding bladder-directed local therapy for MIBC is based on physicians' and patients' preferences, and does not take into account tumor biology. Predictive biomarkers, once validated, could offer a more patient-centered and biology-driven selection of bladder-directed therapies.
We provide a narrative review of clinical data pertaining to the biomarkers in bladder preservation management of MIBC.
There are currently no validated and clinically used biological markers used for stratification of radical bladder treatment and selection of bladder-preserving therapies. This article summarizes biomarkers that could have a potential clinical utility-PD-L1, molecular subtypes, Ki-67, MRE-11 and markers of hypoxia-and offers a hypothetical pathway model for a marker-driven precision management of medically operable patients with a newly diagnosed MIBC.
When selecting the optimal cancer treatment, both patient and tumor factors need to be considered. Once validated, biological markers will help clinicians tailor the management of MIBC to individual patients.
局部肌肉浸润性膀胱癌（MIBC）患者可以选择接受新辅助化疗加根治性膀胱切除术，或基于放疗的膀胱保留治疗方式，并随后密切进行膀胱镜监测，对有局部疾病复发证据的患者保留挽救性膀胱切除术。目前，针对 MIBC 的膀胱定向局部治疗决策基于医生和患者的偏好，而未考虑肿瘤生物学。一旦得到验证，预测性生物标志物可以为膀胱定向治疗提供更以患者为中心和以生物学为驱动的选择。
我们对与 MIBC 的膀胱保留管理相关的生物标志物的临床数据进行了叙述性综述。
目前尚无用于 MIBC 的根治性膀胱治疗分层和膀胱保留治疗选择的经过验证和临床应用的生物标志物。本文总结了一些可能具有潜在临床应用价值的生物标志物，包括 PD-L1、分子亚型、Ki-67、MRE-11 和缺氧标志物，并提出了一个用于新诊断为 MIBC 的可手术患者的基于标志物的精准管理的假设性途径模型。
在选择最佳癌症治疗方法时，需要考虑患者和肿瘤因素。一旦得到验证，生物标志物将有助于临床医生根据个体患者的情况来管理 MIBC。
