Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA; Cancer Center, Massachusetts General Hospital, Boston, MA, USA.
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, USA.
Lancet Oncol. 2018 Dec;19(12):e683-e695. doi: 10.1016/S1470-2045(18)30693-4.
Although muscle-invasive bladder cancer is commonly treated with radical cystectomy, a standard alternative is bladder preservation therapy, consisting of maximum transurethral bladder tumour resection followed by radiotherapy with concurrent chemotherapy. Although no successfully completed randomised comparisons are available, the two treatment paradigms seem to have similar long-term outcomes; however, clinicopathologic parameters can be insufficient to provide clear guidance in the selection of one treatment over the other. Recent advances in the molecular understanding of bladder cancer have led to the identification of new predictive biomarkers that ultimately might help guide the tailored selection of therapy on the basis of the intrinsic biology of the tumour. In this Review, we discuss the existing evidence for molecular alterations and genomic signatures as prognostic or predictive biomarkers for bladder preservation therapy. If validated in prospective clinical trials, such biomarkers could enable the identification of subgroups of patients who are more likely to benefit from one treatment over another, and guide the use of combination therapies that include other modalities, such as immunotherapy, which might act synergistically with radiotherapy.
虽然肌层浸润性膀胱癌通常采用根治性膀胱切除术治疗，但标准的替代方案是膀胱保留治疗，包括最大限度经尿道膀胱肿瘤切除术，随后进行放化疗。尽管目前尚无成功完成的随机对照比较，但这两种治疗方案似乎具有相似的长期疗效；然而，临床病理参数可能不足以在选择一种治疗方案而不是另一种治疗方案时提供明确的指导。对膀胱癌分子机制的深入了解已经导致了新的预测生物标志物的出现，这些标志物最终可能有助于根据肿瘤的内在生物学特性，对治疗方案进行个体化选择。在这篇综述中，我们讨论了现有证据，以确定分子改变和基因组特征是否可作为膀胱保留治疗的预后或预测生物标志物。如果在前瞻性临床试验中得到验证，这些生物标志物可以帮助确定更有可能从一种治疗中获益的亚组患者，并指导联合治疗的使用，包括其他方式，如免疫疗法，其可能与放疗协同作用。
