Chandrasekar Thenappan, Erlich Annette, Zlotta Alexandre R
Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University of Toronto and University Health Network, Toronto, ON, Canada.
Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.
Curr Urol Rep. 2018 Nov 3;19(12):107. doi: 10.1007/s11934-018-0853-5.
Bladder cancer (BCa) management had remained unchanged for 20+ years with clinicians, in contrast to many other cancer types, rarely relying on molecular characteristics to guide management. The past 5 years have yielded significant advances in our knowledge of the molecular basis of BCa and concurrent advances in systemic therapy. We aim to highlight the key developments and potential future direction of BCa management.
Next-generation sequencing (NGS) has drastically altered the understanding of muscle-invasive BCa (MIBC) and non-muscle invasive BCa (NMIBC). MIBC molecular subtyping efforts from several groups worldwide grouped into an international consortium into five classes, broadly grouped into basal and luminal subtypes, have attempted to improve prediction of clinical outcomes and treatment response, either chemotherapy or immunotherapy. NMIBC molecular subtyping is yielding similar disease stratification, superior to histopathology alone. Additionally, with new actionable targets being identified for patients non-responsive to traditional therapy, ongoing and upcoming clinical trials are increasingly emphasizing the importance of the molecular testing. The molecular characterization of bladder cancer is rapidly progressing and will likely alter treatment paradigms in the near future.
与许多其他癌症类型不同，膀胱癌（BCa）的治疗方法在20多年来一直没有改变，临床医生很少依靠分子特征来指导治疗。在过去5年里，我们对BCa分子基础的认识取得了重大进展，同时全身治疗也取得了进展。我们旨在强调BCa治疗的关键进展和未来潜在的方向。
新一代测序（NGS）极大地改变了对肌层浸润性膀胱癌（MIBC）和非肌层浸润性膀胱癌（NMIBC）的认识。来自世界各地几个团队的MIBC分子亚型研究工作组成了一个国际联盟，将其分为五类，大致分为基底型和腔面型亚型，试图改善对临床结果和治疗反应（化疗或免疫治疗）的预测。NMIBC分子亚型分类也产生了类似的疾病分层，优于单纯的组织病理学。此外，随着针对对传统治疗无反应的患者确定了新的可操作靶点，正在进行和即将开展的临床试验越来越强调分子检测的重要性。膀胱癌的分子特征正在迅速发展，可能在不久的将来改变治疗模式。
