Pang Karl H, Noon Aidan P
Academic Urology Unit, University of Sheffield, Sheffield, UK.
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
Transl Androl Urol. 2019 Feb;8(1):101-107. doi: 10.21037/tau.2018.09.06.
Bladder cancer (BC) is a common disease in both sexes and majority of cases present as non-muscle invasive BC (NMIBC). The percentage of NMIBC progressing to muscle invasive BC (MIBC) varies between 25% and 75% and currently there are no reliable molecular markers that may predict the outcome of high-risk (HR) NMIBC. Transurethral resection of the bladder tumour (TURBT) with intravesical bacillus Calmette-Guérin (BCG) or immediate radical cystectomy (RC) are the current gold standard treatment options. The European Association of Urology (EAU) guidelines recommend immediate or delayed RC for HR- and a subgroup of "highest-risk" NMIBC. These cases include pT1, carcinoma in-situ (CIS), multifocal disease, histological variants such as micropapillary and sarcomatoid, and patients who have contraindications to, or have failed with BCG. The comparative risks between maintenance BCG (mBCG) and immediate RC are unclear. However, RC may give patients the best oncological outcome.
膀胱癌（BC）是一种常见的两性疾病，大多数病例表现为非肌层浸润性膀胱癌（NMIBC）。NMIBC进展为肌层浸润性膀胱癌（MIBC）的比例在25%至75%之间，目前尚无可靠的分子标志物可预测高危（HR）NMIBC的预后。经尿道膀胱肿瘤切除术（TURBT）联合膀胱内卡介苗（BCG）或立即根治性膀胱切除术（RC）是目前的金标准治疗方案。欧洲泌尿外科学会（EAU）指南建议对HR-NMIBC和“最高风险”NMIBC的一个亚组立即或延迟行RC。这些病例包括pT1、原位癌（CIS）、多灶性疾病、组织学变异如微乳头和肉瘤样，以及对BCG有禁忌证或BCG治疗失败的患者。维持性BCG（mBCG）和立即RC之间相对风险尚不清楚。然而，RC可能给患者带来最佳的肿瘤学结局。
