Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Urology, University of Tübingen, Tübingen, Germany.
World J Urol. 2019 Jan;37(1):61-83. doi: 10.1007/s00345-018-2606-y. Epub 2019 Jan 25.
To provide a comprehensive overview and update of the Joint Société Internationale d'Urologie-International Consultation on Urological Diseases (SIU-ICUD) Consultation on Bladder Cancer for muscle-invasive presumably node-negative bladder cancer (MIBC).
Contemporary literature was analyzed for the latest evidence in treatment options, outcomes, including radical surgery, neoadjuvant and adjuvant treatment modalities, and bladder-sparing approaches. An international multi-disciplinary expert panel evaluated and graded the data according to guidelines from the Oxford Centre for Evidence-Based Medicine.
Radical cystectomy (RC) is the standard of care for MIBC patients considered to be surgical candidates. While associated with substantial morbidity and mortality, this has been mitigated with improved technique, minimally invasive technology, and better perioperative care pathways (e.g., enhanced recovery after surgery). Neoadjuvant (NA) cisplatin-based combination chemotherapy improves overall survival and should be offered to eligible ≥ cT2N0 patients. Adjuvant (Adj) cisplatin-based combination chemotherapy may be considered, particularly for pT3-4 and/or pN+ disease without prior NA chemotherapy. Trimodal bladder-preserving treatment via maximum transurethral resection of bladder tumor followed by concurrent chemoradiation is safe and, when combined with early salvage RC for recurrence, offers long-term survival rates in selected patients comparable to RC. Immunotherapy is still experimental and is given either alone or in combination with chemotherapy and/or radiation.
A multi-disciplinary approach is paramount to achieving optimal outcomes for MIBC patients, irrespective of their age, performance and nutritional status, fitness/frailty, renal and other organ function, or disease severity.
提供肌层浸润性、疑似淋巴结阴性膀胱癌（MIBC）的国际泌尿外科学会-国际泌尿疾病咨询（SIU-ICUD）膀胱癌咨询的全面概述和更新。
分析了当代文献，以获取治疗选择、结果的最新证据，包括根治性手术、新辅助和辅助治疗方法以及保留膀胱的方法。一个国际多学科专家小组根据牛津循证医学中心的指南评估和分级数据。
根治性膀胱切除术（RC）是被认为是手术候选者的 MIBC 患者的标准治疗方法。虽然与大量发病率和死亡率相关，但随着技术的改进、微创技术和更好的围手术期护理途径（例如手术后的快速康复），这种情况已经得到缓解。新辅助（NA）顺铂为基础的联合化疗可提高总生存率，应提供给符合条件的≥cT2N0 患者。辅助（Adj）顺铂为基础的联合化疗可能是考虑的，特别是对于没有先前 NA 化疗的 pT3-4 和/或 pN+疾病。最大限度经尿道膀胱肿瘤切除术联合同期放化疗的三联膀胱保留治疗是安全的，当与早期补救性 RC 联合用于复发时，可在选定患者中提供与 RC 相当的长期生存率。免疫疗法仍处于实验阶段，可单独使用或与化疗和/或放疗联合使用。
无论患者的年龄、表现和营养状况、体能/虚弱状况、肾功能和其他器官功能或疾病严重程度如何，多学科方法对于 MIBC 患者获得最佳结果至关重要。
